Sleep During Pregnancy: Mental and Emotional Changes
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DR. BARBARA L. PARRY: You’re pregnant and you’re tired. You’re newly postpartum and you’re exhausted. Is sleep deprivation just a harmless part of pregnancy and postpartum or it should be taken more seriously. I’m Dr. Barbara Parry, professor of psychiatry in the University of California in San Diego and today we’re learning all about the mental and emotional health aspects of sleep in pregnancy. This is Preggie Pals.
STEPHANIE GLOVER: Welcome to Preggie Pals, broadcasting from the birth education center of San Diego. Preggie Pals is your online on the go support group for expecting parents and those hoping to become pregnant. I’m your host Stephanie Glover. Thanks to all of our loyal listeners who’ve joined the Preggie Pals club.
Our members get special episodes, bonus content after each new show plus special giveaways and discounts. See our website for more information. Another way that you can stay connected is by downloading our free Preggie Pals app available in the Android, iTunes and Windows market places. Samantha our producer is now going to give us information about our virtual panelist program.
SAMANTHA EKLUND: Thanks Stephanie. So if you’re not in San Diego but you want to be a part of our discussion here at Preggie Pals. We have this program called the virtual panelist program. So go over to New Mommy Media at Facebook and the Preggie Pals Facebook. Like us and follow us on Instagram using #preggiepals. We’ll post our questions before the show starts and if you comment we can incorporate your thoughts into our episode. To learn more head over to our website www.preggiepals.com.
STEPHANIE GLOVER: Well great. Thank you. So we’ll go ahead and just introduce ourselves as panelist. I’ll go ahead and start my name is Stephanie Glover. I’m 32 years old. I’m the host of Preggie Pals and as well as a stay at home mom to two daughters. Gretchen is almost 3 and Lydia is 10 months old. My, both of my births were hospital births. The first was a caesarean and the second a VBAC.
SUNNY GAULT: Hey everyone I’m Sunny. Samantha and I are going to duke out who goes next. I am the owner of New Mommy Media which produces the show as well as Parent Savers, Twin Talks and The Boob Group and I am mommy to four children currently under the age of 4 all of them. So my oldest is turning 4 at the end of next month and my middle guy is 2 years old and I have identical twin girls who are about seven and a half months old now. And so birth wise I had my first was a vaginal birth and then I had two caesarean births.
SAMANTHA EKLUND: Alright. I’m Samantha, I’m the producer of Preggie Pals. I’m 22 years old. I am a mom to a 20 month old named Olivia. She was an unplanned caesarean birth and I’m hoping for a VBAC sometime in the future.
STEPHANIE GLOVER: One of our listeners writes in with the question for our experts. She writes I’ve read that waiting to cut the umbilical cord for up to three to five minutes has quantifiable benefits for the baby. If I’m considering cord blood donation to a public bank not for private use, is there less likelihood there will be enough cells blood etc. in the cord if we wait to cut. I think on one of your recent podcast I heard that up to 70% of donations are discarded because there’s not enough use. Thanks.
DR. NICHOLAS CAPETANAKIS: Hi my name is Dr. Nicholas Capetanakis and I’m a board certified OBGYN in San Diego California. I just wanted to respond to a great question. I was asked about cord blood banking and also waiting for the cord to stop pulsating. The research does show that if you do wait up to 3 to 5 minutes for the cord to stop pulsating at the time of delivery then when you do go to collect the cord blood banking whether it’s for private or for donation that there is a lower volume and it would make sense that the majority of that blood flow would flow to the baby there is some that goes back to the placenta.
However when you go to collect the volume that you do have left in the collection kit is less. Sometimes when you are doing it for donation, if the numbers are not high enough the cord blood company will reject the sample as not enough cells for use. If you are doing it for private banking in my personal practice I do talk to patients about maybe doing a delayed clamping for a minute and then obtaining the core blood so that we can have enough volume in the cord blood collection kit and also give some to the baby. Now for years we use to cut the cord immediately but now we are realizing there are benefits to the baby if we do the delayed cord clamping. Hope that answers your question and I hope you have a great day.
STEPHANIE GLOVER: Today we’re going to be talking about how sleep in pregnancy affects the mental and emotional wellbeing of pregnant women. Joining us here on our studio is Dr. Barbara Parry, professor of psychiatry at the University of California in San Diego where she is director of research of the Women’s Mood Disorders clinic. Welcome to Preggie Pals Dr. Parry it’s great to have you.
DR. BARBARA L. PARRY: Thank you.
STEPHANIE GLOVER: How important is sleep in pregnancy and why is it so important.
DR. BARBARA L. PARRY: Sleep is important not only in pregnancy that other times first it’s played a restorative function into the brain. It helps in memory consolidation. Without sleep your immune system is compromised, but one thing I’d like to emphasize is that one of my colleagues Dr. Thomas Wyrr at the National Institute of Health has emphasized that our ancestors and animals have two epics of sleep where they sleep in the early part of the night then they have a period of quiet wakefulness and then they have a second epic sleep. And during that period of quiet wakefulness is when prolactin or mela-hormone is secreted. That’s the hormone that’s also involved in lactation.
STEPHANIE GLOVER: Yeah.
DR. BARBARA L. PARRY: And in our modern day society we feel like we have to truncate our sleep into you know 7 or 8 hours and people get very anxious if they don’t get this 7 or 8 hours of sleep and I would tell one of the first things to say to pregnant postpartum women is that you know there’s a lot of redundancy in this system the designer accounted for having to be up at times. So losing a partial amount of sleep is not a big issue. It will not cause a major depression but a depression can cause sleep disturbance and I think the emphasis needs to be there.
So it is more chronic stress and chronic sleep disturbances that are problematic. So you know going to sleep early like when you go to sleep when the sun goes down and then you have a period of quiet wakefulness where you’re in touch with your dream or talking to God is and then you go back to sleep is the really the more natural state of sleep. So I think it would but women if they’re you know they wake during the middle of the night and they’re sleeping quietly that’s healthy.
STEPHANIE GLOVER: Yeah.
DR. BARBARA L. PARRY: And that’s actually more to be recommended than trying to you know cram it in to 7 or 8 hours and then getting very anxious oh I didn’t get my 8 hours of sleep last night I’m not going to be able to function.
STEPHANIE GLOVER: Imagine it takes some pressure off.
DR. BARBARA L. PARRY: Yes. And I think that you know sleep hygiene is probably the best way to treat sleep disturbances. I mean going to bed around the same time every day. People get into trouble when they for example get up at 6 am every day for work and then they try to go to sleep at 10 am on the weekend. We call that social jet lag and that’s associated with eating disturbances and weight disturbances and so staying on a regular sleep schedule is very important.
STEPHANIE GLOVER: And how do naps come into play like throughout the day. Is that recommended or…
DR. BARBARA L. PARRY: Well there’re two primary drives for sleep. We call them the process C and process S or so homeostatic drive which the longer you’re awake the more you’re likely to go to sleep and that’s what we call a circadian drive so it’s hard to sleep but like 7 pm at night or 10 in the morning and so those interact so you may have notice that if you stay up late partying you’re still going to wake up at your usual time. Well that’s actually pretty healthy.
So you know taking naps in the afternoon which is going to be very common for pregnant women because progesterone is secreted. Progesterone is like essentially an anaesthetic in animals. It puts animals to sleep. And when progesterone goes up in pregnancy you know like tenfold so women are going to be sleepy and for the most part. And so if you’ve been sleeping in the afternoon, well then you’re not likely to sleep at night.
So I think, you know, you should give in to it but you know taking not more than about an hour or two of a nap is probably for the best and of course no caffeine or alcohol. I mean alcohols people think that that helps them sleep but that’s terrible during pregnancy and it just wakes them up. And then the other thing that is important with people who can’t sleep is we have what we call a pious parchment pile, a PPP. You don’t want to wake and toss and turn and you want to get up and read your pious parchment pile. It could be the history of education in the US you know I had one medical journal. So you want to be able to not just use the bed for sleep.
So you don’t want and you shouldn’t watch TV in the bedroom. You want to associate the bedroom with sleep. So let’s say if you can’t sleep, you get up, you write in your worry journal, you read your PPP until you feel the weight of sleep coming back but this idea that the bedroom is for TV, TV is very activating for your brain and so you do not want to be watching TV in the bedroom.
STEPHANIE GLOVER: I’m guilty of that. How about you?
SUNNY GAULT: I am too. I am too.
STEPHANIE GLOVER: And then I don’t know about how your pregnancy is were for you with fatigue but I remember in the beginning I was so tired that I couldn’t not maybe take a little cat nap in the car on my lunch break when I was still working and so but you would recommend just giving in as long as it’s not over an hour or…
DR. BARBARA L. PARRY: Well it’s adaptive…
STEPHANIE GLOVER: Yeah.
DR. BARBARA L. PARRY: I mean one of the functions of progesterone so women aren’t out you know running and overdoing it when they’re pregnant. You want to be you know [inaudible] and getting some rest and so it’s probably adaptive for that purposes but…
STEPHANIE GLOVER: And what are some sciences of sleep deprivation? Isn’t that just you know is it just the normal part that of pregnancy to just feel really tired and get on with it or are there ways that we can treat it?
DR. BARBARA L. PARRY: Actually it sounds ironic but if you’re sleep deprived in at a critical stage for a let’s say for at least like 4 hours. It kicks in your thyroid and it’s one of the great paradoxes of life but if someone has a depression if you keep them up all night a majority of them of women are better the next day and then and women so it is very, very activating and then that allows them to go back to sleep the following night. So again I’ve reiterate this point of not being able to sleep too well one night is not a problem and the progesterone is probably influencing the sleepiness and is a good thing. I mean it’s meant to keep you sort of taking a nap in the middle of the day and not overdoing it.
STEPHANIE GLOVER: If a woman hasn’t really recovered the instances of sleep deprivation like on a smaller scale if she’s just having problems sleeping for maybe several days, weeks, are there anything any additional things that she can do with anything recommended for treatment beyond just scheduling your sleep and taking the TV out of the room?
DR. BARBARA L. PARRY: I want to emphasize one thing not to do because I saw this on this write up you don’t want to take melatonin.
STEPHANIE GLOVER: Okay.
DR. BARBARA L. PARRY: Melatonin is inhibitory to the reproductive system. In animals in hamsters it’s an elegantly designed system but when if you’re a hamster when there is an increased darkness during the winter months there’s more melatonin secreted that melatonin shuts down the reproductive access so the hamster doesn’t reproduce during the winter when there is no food and so when the spring comes and there is more light that suppresses the melatonin and then allows for them to recrudescence the reproductive system and for what we know humans are what we call photo periodic they also change with the season.
It may not be as a parent so you don’t want to be taking melatonin to shut off your reproductive system. I mean it’s a pretty robust system so you know to maintain the pregnancy you’ve got you know plenty of your estrogen and progesterone around but some people think, Oh! you know this over the counter things and I would say no.
STEPHANIE GLOVER: That’s fascinating.
SAMANTHA EKLUND: Interesting.
SUNNY GAULT: It is.
STEPHANIE GLOVER: Do you not recommend melatonin in general for anybody say you know a male of child bearing age say he melatonin because he can’t sleep on a regular basis. Do you even discourage that because it’s just generally not good for your reproductive system at all?
DR. BARBARA L. PARRY: Oh no, no I think it’s, it can be very helpful for shifting the circadian rhythm.
STEPHANIE GLOVER: Okay.
DR. BARBARA L. PARRY: So for example if someone is you know we intend to be either [inaudible] or owls, morning people or evening people. You know as Ben Franklin said that early to bed early to rise makes a person healthy, wealthy and wise. And so and people who are more owls tend to have more problems with weight gain and sleep disturbance and mood disturbances.
But light is the most powerful synchronizer of circadian rhythm so if you get out and it’s got to be bright light and you got to have your eyes open. But if you go let’s say you’re an owl type person you can’t get to sleep taking a walk in the early morning hours will help shift that rhythm earlier. And light in the evening will tend to shift it later. Now we know women from our studies, the women who tend to be pregnant, who are pregnant tend to be more shifted earlier and the women who are postpartum tend to be shifted later. That’s the effect of the changing reproductive hormones from all the evidence we have.
So the other way you can you know improve sleep as you get out and you’re active and you get light during the day that’s going to increase your natural melatonin at night and help you sleep better. So the healthy lifestyle of you know, activity in light you know there’s more of a contrast and making sure the room is cool and dark so the brain thrives on that contrast. So you know just sort of being in dim light is not good for our brains and we have more awakening so…
SAMANTHA EKLUND: Oh how interesting.
STEPHANIE GLOVER: It’s interesting yeah. Well great. So when we come back we’ll discuss sleep in relation to mood disorders. We’ll be right back.
STEPHANIE GLOVER: So welcome back. Today on Preggie Pals we’re discussing sleep in pregnancy in regards to mental and emotional health. Dr. Barbara Parry is our expert. So can sleep deprivation lead to other mental or emotional conditions?
DR. BARBARA L. PARRY: Well I want to emphasize that for example depression one of the most characteristic features of depression is sleep disturbance and it often heralds the onset of depression. So for example a woman who is a postpartum after delivery if she can’t sleep even when the child is sleeping, we want to watch her very carefully because that can predate the onset of depression.
So and ironically this is one of life’s great paradoxes but if you take someone who is depressed and you keep them up all night, you don’t even have to keep them up all of night just half of the night, a majority of them are better the next day. It works better than any anti-depressant. The problem is, is that when they go back to sleep they may get their depression back again. So we’re now trying to . . . if we can get this anti-depressant effect of restricting sleep then we can maintain it with light but light just takes longer to work.
So we’re trying to at least in our studies, and they’ve done this in other studies as well we’re focusing on the pregnant postpartum women. We try to get the anti-depressant effect and then maintain it with light. So it’s much more that sleep and depression are linked. So you don’t really cause by you know a night of sleep deprivation. You don’t cause a major depression that would take like six months of you know stress and chronic insomnia.
It might exacerbate it but if you’ve been up all night for whatever reason you may find that you feel a little buzzed you know and that’s your thyroids kicking in so you may actually feel more energized. So and most anti-depressants ironically work by knocking out a certain stage of sleep called rep and eye movement or rem sleep when we do most of our dreaming. And so there was an investigator who just woke people up when they went into this rem sleep and they have anti-depressant effects. So there is a very tight link between sleep and depression but most of the, if you got depression inevitably you’re probably going to have sleep disturbance. But sleep disturbance in it of itself does not lead to major mental illness.
STEPHANIE GLOVER: That’s great to know and have either of you experience that buzz that she talks about like you’re up all night maybe with the baby and you just don’t think you can function but all of a sudden you have maybe some burst of energy have either of you felt that?
SAMANTHA EKLUND: Yeah like a second wind.
STEPHANIE GLOVER: Yeah.
SAMANTHA EKLUND: Almost it’s like you’re so tired in the morning because you hadn’t slept very well but in the afternoon it was like okay like this is alright maybe I’ll make it until 8pm when I know I can go back to sleep so yeah I think there are a lot of days in the early postpartum days when I did have that.
STEPHANIE GLOVER: Yeah I can even see it now my daughter is 10 months but not a good sleeper. So we’re still up some nights it feels like I still have a newborn and there you know you get up in the morning and then part of you is thinking [inaudible 00:19:26] I don’t know how I can go through this day and part of me wonder if it was mind over matter because I wouldn’t notice. All of a sudden I cleaned the house I don’t know where I drew up this energy. But maybe it wasn’t my mind over matter at all.
DR. BARBARA L. PARRY: Well I should let you know that melatonin in the child usually goes up about 3 months postpartum so it’s about 3 months when most children start sleeping through the night.
STEPHANIE GLOVER: Can you give babies melatonin?
DR. BARBARA L. PARRY: They’ve began to, they have begun to.
STEPHANIE GLOVER: Because mine is 10 months old and it’s not looking like it’s any time soon. And so you’ve mentioned this light study. Is that used as treatment yet or is this still just being looked into more?
DR. BARBARA L. PARRY: Well it is in experimental treatment.
STEPHANIE GLOVER: Okay.
DR. BARBARA L. PARRY: But yes again ironically you know women who are depressed either during pregnancy or postpartum are not always good candidates for medication. There are some medications that can be used safely but many women choose not to use them. So we find that if we ironically keep them up just for half the night it has to be of like 4 hours straight. It can’t be just tossing and turning and it’s depending upon if their biological rhythms were shifted earlier or later.
We keep them up even in the first half of the night or the second half of the night and the majority of them feel much better the next day. And then we maintain that effect with the light treatment and again the timing of the light depends upon their own internal rhythms so we are trying to develop non-pharmacologic treatments for this and if anyone in the San Diego area is interested in participating, can I mention the number?
SUNNY GAULT: Absolutely.
DR. BARBARA L. PARRY: And so that number is area code 619-543-7393.
STEPHANIE GLOVER: Great! Thank you. And are there any effects on the baby of the sleeplessness that can occur in pregnancy and postpartum? Are there any directly related effects to the baby?
DR. BARBARA L. PARRY: Well we know that depression definitely affects the foetus as well as the infant and that has long term repercussions. So you know, one night of partial sleep deprivation we have not noticed any adverse effects but if you can bring someone out of a depression you’re definitely going to be helping the child again in utero or postpartum and we can get that effect within one day unlike most other for example anti-depressant medications to take at least 3 weeks to work. So and they usually then we monitored their sleep the sleep improves the following night.
What happens is their melatonin under circadian rhythms are maladjusted in terms of the time with the timing with relation to sleep and so this sort of like resets the rhythm. Sort of like if you had any irregular heartbeat, if you have a little bit of a shock, you set reset the rhythm until we’re essentially resetting the rhythm. We’re overwriting the irregularity.
SUNNY GAULT: So if it affects the child do we know in what ways and I don’t want to get too medical on this but in what ways it can impact the child like sleep deprivation for the mother who is pregnant, do we know what that can do to a baby in utero exactly?
DR. BARBARA L. PARRY: No because I mean I think it’s natural that a woman is going to use you know...
SUNNY GAULT: Yeah.
DR. BARBARA L. PARRY: Lose sleep at some point.
SUNNY GAULT: Yeah sure.
DR. BARBARA L. PARRY: I mean if you’re like a whale you migrate down for 6 months and the whale gets no sleep. If you’re a dolphin it only sleeps on half of their brain.
SUNNY GAULT: Yeah.
DR. BARBARA L. PARRY: And so whoever designed the system is going to account for that.
STEPHANIE GLOVER: Okay.
DR. BARBARA L. PARRY: So we have not noticed adverse you know I mean anyway we can measure…
SUNNY GAULT: Yeah.
STEPHANIE GLOVER: Okay.
DR. BARBARA L. PARRY: We have not observed any abnormal effects but again I need to emphasize that a depression we know will affect the foetus and the child.
STEPHANIE GLOVER: And so in relation to light and just other environmental factor so we know maybe no TV in the room but what other things can we do within our sleeping environment to help us? Do black out curtains help sort of any other thing we could do with…
DR. BARBARA L. PARRY: Yes. A cool dark room and the other effect to that regulates sleep is temperature. So the idea of a hot bath you know around 4 to 5 hours before sleep onset time you know where exercise around you know like 4 to 6 pm because basically that heats up your core body temperature and then you need to produce that. You need to like hibernate.
So the old night caps and socks at the beginning of bed so that you’re warm when you go to bed but then it allows you to expand your arteries and vein to loose heat. So it should be you know it should be you have warm feet and a warm head when you go to bed and then you should have a very cool dark room you know without noise. You shouldn’t have you know a lot of light and if you get up to use the restroom you should not turn on bright lights because that will shut down your melatonin.
So you want to have those little night lights and very dim light. I remember my mom came to visit and I purposely hid you know my, the lights over my bathroom sink like were very dim. You know we need to get new lights and I said no no because Dr. [inaudible] from Harvard is recommend that we only use lights that’s very dim.
STEPHANIE GLOVER: And you should probably then turn the cellphone…
SUNNY GAULT: Yeah.
DR. BARBARA L. PARRY: Yeah.
STEPHANIE GLOVER: Text messages off so that that’s not waking you up.
DR. BARBARA L. PARRY: Yes and the computer.
STEPHANIE GLOVER: Right.
SUNNY GAULT: All of that’s probably rings right up there with TV.
STEPHANIE GLOVER: Yeah.
SUNNY GAULT: Right as far as stimulating yourself.
STEPHANIE GLOVER: Yeah.
DR. BARBARA L. PARRY: And then things like you know tryptophan as in milk or bananas [inaudible] serotonin which helps you sleep. So a glass of warm milk, little before bed time not big carbohydrate meals. You know bananas are good and you know eating a healthy diet so that you’re not you need to have a period were you don’t have a lot of calories during the middle of the night to function well.
STEPHANIE GLOVER: Well thank you so much Dr. Parry for joining us. For more information about Dr. Parry and the Women’s Mood Disorders Clinic as well as the study for lights and for sleep and light therapy in relation to pregnancy and postpartum depression, that phone number again is 619-543-7393 and that’s available to San Diego listeners. You can also check out more of that information on our website www.preggiepals.com. This conversation continues for members of our Preggie Pals club. After the show Dr. Parry is going to be discussing sleep deprivation in postpartum and in relation to breastfeeding. To join our club, visit our website www.preggiepals.com .
KRYSTAL STEVENDECK: Hello Preggie Pals. I’m Krystal Stevendeck, maternity fashion expert founder of “Borrow for your bump” where you can buy or rent maternity style for a monthly rate. Today we’re going to talk about the upcoming fall fashion trend for moms to be. These little ideas in wardrobe essentials are stylish and versatile as your bump grows and can easily transform your look as the new season approaches. Trend number one is the long slit mini.
The key to their statement dress is to show skin in some areas while keeping others covered up. We love more slit dials that show up more life. The trick is to keep the slit loose and flawless. Add a belt or tie over the bump which will create curve. For fall we love the color who condiment. Think all greens and mustard yellows. To tie those altogether avoid skinny heel and try a comfy wedge boot.
Trend two is sexy stripe, whether you are more on the hippy side or if you want to create curve, stripe is one detail that works for many body types. Stick with inner stripe in dark colours. Wider stripes can make your bump and back side appear larger. Focus on a fit that hugs your curve and has loose side. This type of dress looks good on many body types whether you want to create curve or even balance wide hip. Tie the look together with some black knee high boot.
For our third trend, prints are all the hype this fall. Have fun with different styles but make sure that the color is match. We love a silky print dress for more dressed up [inaudible] purple and aqua tone. Dress prints down by taking a fun size blouse and pairs it with skinny jeans. For colors we love orange, navy and cream with a tan boot. You’re probably seeing this next trend everywhere, leather.
We love this look for moms to be. Pair a comfy pair of stretch leather leggings with the basic grey sweater or for a retro look try a navy polka dot blouse and a fun brightly colored heel. Add a funny head piece like the bird cage for a sleek style.
Our final trend for fall is dressed up detail. An incredible cocktail dress that can be worn from fall into winter is a must have. Try up the standard little black dress and find a style with beaded detail on entire waist. An LBB with a little bit of laces also [inaudible]. Many of this fall trends can be found at www.borrowforyoubump.com. Enter promo code Preggie Pals at checkout to save 20% on your entire order. Thanks for listening to today’s fall fashion trends and be sure to listen to Preggie Pals for more great pregnancy tips.
STEPHANIE GLOVER: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister shows
• Parent Savers for parents with new born, infants and toddlers
• Twin Talks for parents of multiples
• Our show The Boob Group for moms who breastfeed their babies
This Preggie Pals; “Your Pregnancy Your Way”
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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