If you are pregnant and you have trouble breathing at night, you are not alone. This condition is called sleep-disordered breathing in pregnancy. It can range from mild snoring to a more severe condition called obstructive sleep apnea (OSA).
OSA is loud snoring interrupted by brief periods of not breathing, called apnea. Periods of apnea may be accompanied by sounds of choking or gasping. OSA causes poor sleep and periods of low oxygen. This is not good for you or your baby. You may wake up with a headache and feel sleepy during the day. Unless a sleeping partner tells you about your snoring and gasping, you may not know you have OSA.
OSA during pregnancy has been linked to an increased risk for high blood pressure. High blood pressure during pregnancy – called preeclampsia – can be dangerous for you and your baby. OSA may increase your risk for diabetes during pregnancy (gestational diabetes). OSA has also been linked to stress on your baby that may cause slowed growth (fetal growth retardation).
Are You at Risk for OSA?
The number of pregnant women who have OSA is not known. It is known that about six percent of women of childbearing age have OSA. Pregnancy makes OSA worse, so we can assume that the number is higher than six percent. To understand how pregnancy increases your risk for OSA, you need to understand the causes of OSA.
OSA occurs when tissues in your nose or throat become weak or swollen. This allows the tissues to collapse inward while you sleep. The collapse closes your airway. As your oxygen level falls, your brain is triggered to wake you up. You gasp and start breathing again. You may not be completely awake, but your sleep has been interrupted.
This is how pregnancy makes OSA worse:
- Pregnancy causes weight gain that makes breathing harder.
- The baby in your womb presses up against your diaphragm. That also makes breathing harder, especially when you are lying down.
- Increased estrogen during pregnancy causes swelling and fluid to build up in your nose and throat. That narrows breathing passages, especially when lying down.
OSA is most common during the second and third trimester. You may be at higher risk if:
- You gain too much weight during pregnancy.
- You were overweight before pregnancy.
- You already snored before pregnancy.
- You were a smoker before pregnancy. Smoking increases fluid and swelling in your nose and throat.
Diagnosis of OSA
If you have symptoms of OSA, or if you are at risk, you should ask a sleep partner to listen to your breathing at night. If you think you might have OSA, talk to your doctor. OSA is diagnosed with a sleep study. During the study, your oxygen levels, breathing rate, and blood pressure will be monitored during sleep. The sleep study will be able to tell how severe your OSA is.
These are the symptoms of OSA to watch out for:
- Loud snoring and apnea
- Daytime sleepiness
- Feeling confused or foggy
- Feeling irritable or depressed
- Waking up frequently at night
- Feeling short of breath at night
- Waking up with a headache
- Waking up with a sore throat or dry mouth
Treating OSA in Pregnancy
There are no medications you can take during pregnancy for OSA. There are some steps you can take that can help quite a bit. These include:
- Raise the head of your bed or sleep on a pillow wedge.
- Sleep on your side instead of your back.
- Lose some weight if you need to. Check with your provider on a weight target.
- Reduce nasal congestion with a saline rinse or a stick-on nasal breathing strip.
- Don’t smoke or drink alcohol.
- Don’t take any over-the-counter sleep medications.
- Don’t smoke.
- Avoid caffeine and energy drinks.
If these measures do not help, and you have moderate to severe OSA, your doctor may prescribe a treatment called continuous positive airway pressure (CPAP). CPAP is a mask or nasal insertion that forces air into your airway. You wear it while you sleep. CPAP is a safe and effective way to treat OSA.
Another option for milder OSA is a dental appliance that forces your lower jaw forward. This device may not work for some people. In severe cases of OSA, or in cases where CPAP is not effective, your doctor may prescribe oxygen through a nasal cannula.
After pregnancy, there is a good chance that OSA will improve, especially if you get back to a healthy weight. Once the symptoms go away, you can probably stop treatment. Be aware that if you have OSA with this pregnancy, you will probably have it with future pregnancies. If you wake up with symptoms of OSA, have someone listen to your breathing at night. OSA is nothing to ignore. Being diagnosed and treated is the safest thing for you and your baby.