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Parasomnias and Pregnancy

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Parasomnias are sleep disorders in which unwanted actions, emotions, or perceptions that occur during sleep, or while you are falling asleep, or waking up. This is in contrast with dyssomnias, in which there is a problem with the quality or quantity of sleep, or the sleep schedule. However, a parasomnia can cause a dyssomnia by interrupting your sleep. The unwanted things that happen can be movements, the most notorious being sleepwalking, which doctors call somnambulism. Such movements also include more mild activities. such as teeth grinding (bruxism), and extremely complex activities. Apart from movements, parasomnias also include talking during sleep, other behaviors, hallucinations, or other sensations, such as night terrors. Sleep is a process that cycles through different phases. These include the rapid eye movement (REM) phase and various phases comprising non-REM (NREM) sleep. Parasomnias typically occur during transitions between REM, NREM, and wakefulness, or during partial arousal from NREM sleep. Typically, a person suffering from a parasomnia has no memory of the action and often has trouble staying asleep through the night.

Very little research has been published on the epidemiology of parasomnias during pregnancy. One published study on the topic found a decrease in the occurrence of parasomnias during pregnancy, especially among women having babies for the first time. On the other hand, parasomnias have been reported in association with use of certain medications, notably zolpidem, which is prescribed as a short-term treatment for insomnia, including commonly in pregnant women. It is thought that this happens because the parasomnia prevents you from waking up completely when you would otherwise be going through brief wakefulness phases through the night. Basically, you are in the type of REM-NREM-wakefulness transition periods when parasomnias occur.

Over the years, scientists have debated about whether certain other sleep disorders make parasomnias more or less likely. One example is obstructive sleep apnea (OSA), which was thought to be associated with parasomnias based on a study back in the early 2000s. Several years later, however, scientists determined that this was not the case. In 2019, a study conducted in children demonstrated that treatment of restless leg syndrome (RLS) – unwanted movement of the leg, which can occur either while a person is awake or asleep– with iron supplements decreased the occurrence of parasomnias. This suggests a possible connection between RLS and parasomnias, but much more research is still needed.

Diagnosis of parasomnias puts a lot of emphasis on questionnaires that you fill out regarding your sleep habits and experiences, together with observations reported by either your sleeping partner, or others who live with you. Your doctor must rule out various medical conditions, psychiatric illnesses, medications, and sleep deprivation or sleep schedule issues that could be the real problem. In many cases, sleep testing may be needed, either in an overnight sleep lab, or with home sleep testing equipment.

As for pregnancy, problems than can develop in women with parasomnias depend on the types of parasomnia and to what degree they interferes with your ability to get quality sleep. If a parasomnia leaves you feeling unrested throughout the day, then your overall sleep quality and quantity is not good. This may put you at elevated risk for pregnancy complications, such as gestational diabetes mellitus and gestational hypertension (high blood pressure). You also will be more likely to need a cesarean delivery. In the case of sleepwalking, typically, you get up and walk around and go back to bed without getting into trouble, which in some cases could still allow you good sleep. However, such behavior can extend to extremely complex, potentially dangerous activities, such as preparing and eating food, to driving a motor vehicle, or walking out of an open window. In the case of food, a sleepwalker may consume very unusual snacks, such as a container full of a condiment, or a stick of butter. Such a person may prepare food using hot ovens or stoves and knives. There have even been cases of people claiming sleepwalking as an excuse for homicide.

The consequences of bruxism involve dental issues and problems with the temporomandibular joint. Night terrors typically affect children, rather than women of reproductive age, but if you do have night terrors, you won’t remember them. This is in contrast with nightmares, which occur during REM sleep. Typically, the main consequences of night terrors are with those who live with with the person.

Although parasomnias in a pregnant women should not affect the baby directly, the baby could be affected is the parasomnia ruins the quality of the mother’s sleep, putting her at risk of high blood pressure and gestational diabetes. Pregnant women with high blood pressure are at elevated risk of developing preeclampsia, which requires the baby to be delivered early. In the case of gestational diabetes, the baby is at risk of shoulder injury, if delivered vaginally. Furthermore, if you suffer from a parasomnia that causes you to do something dangerous such as sleep cooking or sleep driving, then of course the baby is also at risk.

Parasomnias are treated with a group of drugs called benzodiazepines, which help prevent parasomnias by reducing the amount of REM sleep and minimizing arousal. Some controversy surrounds the question of how safe these drugs are during pregnancy, but if you have a dangerous parasomnia and such a medicine has been helpful, then the benefit likely outweighs the risk of using them. Furthermore, since stopping such medications generally causes an increase in REM sleep, your parasomnia may possibly worsen if you stop a benzodiazepine abruptly.

As with most sleep disorders, one treatment strategy that is usually recommended before medications are offered is to improve sleep hygiene, meaning to adopt healthy sleep practices, such as going to bed on a regular schedule, avoiding bright lights before going to bed, and avoiding stimulants, such as caffeine, at night. Another useful therapeutic approach is cognitive behavioral therapy, which can help improve your sleep hygiene, but also help you learn to manage stress and to relax.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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