Episode 14: You’re Pregnant, You Can’t Sleep, We Have Answers

Show notes

“This is not the time to completely be your most productive self. You’re already being productive by growing a human! So if you have the opportunity to sleep next to your toddler, please go take a nap. Like, anytime you can, close your eyes and take a nap.”

Dr. Shelby Harris chats with OB-GYN and co-creator of TRIBE CALLED V Dr. Shieva Ghofrany about what matters most when it comes to pregnancy and sleep.

Transcript

Dr. Shelby: How are you sleeping? Are you sleeping? I’m Dr. Shelby Harris, clinical psychologist and Director of Sleep Health at Sleepopolis, where we dive deep into all things sleep. If you like Sleep Talking with Dr. Shelby, take a second right now to like this video on YouTube or give us a five star rating through Spotify or Apple podcasts.

It seems simple, I know, but it helps us reach a lot more people to get them the rest that they deserve. And if you’re tired of hitting that snooze button, hit the subscribe button instead. A new episode of science backed sleep tips is available every other Wednesday.

Is great sleep really possible when you’re pregnant? What changes should we be prepared for across the three long trimesters? And more importantly, if things don’t go as planned, and really, when do they ever? How can our mindset help us pivot and persevere for the best health possible during this transformative time? To answer these questions and more about the ways pregnancy influences sleep, we’ve invited Dr. Shieva Ghofrany.

An OBGYN since 1999, Dr. Shieva has welcomed patients to her private practice, Coastal Obstetrics and Gynecology, for over 20 years. She leverages her experiences as a mother of three and an ovarian cancer survivor to empower women in their health journeys. through the online platform she co founded, Tribe Called V.

Dr. Shieva is very amazingly vocal in guiding her patients and social media followers to overcome their fears and learn more about their health. Dr. Shieva, we are so excited to learn more about our health from you. So thank you for being here and welcome to Sleep Talking with Dr. Shelby.

Dr. Shieva Ghofrany: Dr. Shelby, thank you. I always laugh when people say I’m amazingly vocal because I’m really just vocal about everything. Right?

Dr. Shelby: Right? It’s funny. It’s like just talking about health was taboo for so long and now we’re actually really talking about this stuff, especially OBGYN issues, which we need to be talking about way more. And thank you for being a pioneer in this area. Really.

SG: Well, I’m glad that you have this podcast and this platform because you’re right. We have to talk about it more frequently, more vocally. And I think we have talked about it more casually. So we don’t make it seem so anxiety provoking and taboo. So I’m excited for us to talk about that today.

DS: So during pregnancy, our bodies are pretty much continually growing and changing inside and out. And I found it really quite incredible, all the changes that happen. I have a 14 year old and an eight year old myself. I mean, it’s just amazing what happens. So some of these changes are quite obvious, but others really not so much.

And to better understand our needs and sleep needs during pregnancy, can you talk a bit about the different stages and the changes that happen? Because I always think of it as like first trimester, second trimester, third trimester. What are the changes that happen in our body and sleep needs or sleep changes over those trimesters?

SG: People say to me continuously, no one ever told me this, or I never knew that, you know, X, Y, Z. And I always joke, like, no, I told you, I said it. I’m the one who’s out there. But the truth is, there’s no way to fully prepare anyone. I mean, despite being an OBGYN, when I had my own children, there’s no way I was truly prepared.

Even though I knew what could happen to our bodies and what I would feel, and it had been described to me by my patients, you just don’t know it until you’ve actually been through it. And frankly, I’m not even sure it’s necessarily good to hear every single thing. I mean, I’m a very big fan of preemptive knowledge, and I continuously say to my patients and anyone who will listen, I want to tell you these things ahead of time, not in a way to scare you, but in a way so that I can sprinkle it casually so that when you hear it or feel it, you’re already like, Oh yeah, I remember. I heard something about that.

DS: Yeah.

SG: That said, again, until you’ve gone through it, there’s, there’s really no explaining some of these things. Because as you touched upon, each trimester, our body goes through something different and we can describe the general things that we know might transpire, but every person actually goes through these experiences a little bit differently.

So classically, we say the first trimester, you might remember, you feel really, you know, I describe it as you feel so sleepy –

DS: Yeah.

SG: – that you just want to take a nap. Whereas by the third trimester you’re like sluggish and physically exhausted from the weight and the swelling and potentially all the other things like hemorrhoids and everything that affects you. And then you might be lucky where in that second trimester, you feel better, but people kind of paint this picture of second trimester, you feel great. And I always say well, I don’t know if you’re gonna feel great. You just feel great much better than the first trimester where nausea and again that like, god, I really need to take a nap is overwhelming you.

And you and I know that there’s a lot of physiological reasons for these things to happen outside of the obvious, you’re growing a human, so it’s just going to be tiring, right?

So is the first trimester more about hormonal changes, like that’s really causing the sleepiness? Like, why is it that some – I remember like I had to like stop, I was working at the hospital at the time. I had to like close my door and take a nap sometimes. Like, why is that happening in the first trimester?

This is what I describe to everyone. You just want to take a nap. So there’s a couple of different factors, right? Progesterone’s effect really predominates in the first trimester. So that actually causes you to be kind of sleepy, during the day for some reason. And interestingly, while we give progesterone post-menopausally and perimenopausally now for sleep, as you know. During pregnancy, it seems like the progesterone probably makes you sleepy during the day, but might lead to some of that disordered sleep at night, coupled with the physiologic changes that progesterone also triggers.

For example, progesterone relaxes our GI tract. So you get more reflux. That reflux will wake you up in the middle of the night

DS: Oh.

SG: We don’t really know why exactly, but many of us have a lot of leg cramps in the middle of the night That was something that no matter how much I described it to patients until I had it-

DS: Yeah.

SG: Boy. That is actually one of the most indescribable pains, that until you’ve experienced it, I don’t think anyone can really really understand it. It seems like you’re probably just complaining too much, right? But it is, it is overwhelming and just terrible.

DS: 100%.

SG: And then there’s other things in your first trimester because you might be very nauseated. That might mean you’re not eating nutritionally dense foods, which means you might have less energy from that. Your blood pressure also tends to go down a little bit in that first trimester, which can make you be tired. You might be taking medications for the nausea, specifically these over the counter medications that help with sleep, called doxylamine, that you probably know very well. That’s the one that we actually prescribe specifically for nausea and pregnancy, because it was a prospectively studied medication. So while we’re helping your nausea, we’re making you sleepy.

So these are all the different reasons that we really know about that can actually really cause just exhaustion. Not even counting what we’re going to get into when we get to the third trimester and just the physical aspect of what the growing human is causing to your body.

DS: Yeah, constantly having to go to the bathroom at night. Oh my gosh. But I, I like the way you talked about the second trimester with , you said with your patients, you might say you’ll feel better potentially, but not, I mean, like some people have this idea that the minute they go from first trimester to second, it’s going to be like this glorious change and oftentimes it’s not.

SG: You know, I always joke that everything in life is relative. So, relative to the first, you’ve had potentially like four to 12 weeks of feeling really lousy.

DS: Yeah.

SG: So once you get to that 10 to 12, 10 to 14 week mark and you’re about to be in the second trimester, you might actually kind of feel glorious in that suddenly your nausea is better. Suddenly, you know, a lot of those little things, like that extreme exhaustion, I want to take a nap, like you described might be better. So in that moment, it feels glorious. But at the same time, I also feel like, god, we really kind of oversell these things. And we’re like, you’re going to feel great. And I think that as women.

That’s something that plagues us a lot, right? We’re constantly being told that pregnancy is just so wonderful and it’s just an amazing experience. And listen, as I joke, it’s miserable and magical like everything in life.

DS: How often do you see patients who have the exact same trajectory with multiple pregnancies? So they’re having their first versus their second kid versus the third. Is it always the same symptoms or no?

SG: Nothing is ever ‘always’. Everything is ‘always, and’. I say this a lot, but so it’s no, I would not say it’s always. But I do think to your point, anecdotally, people do seem to have a lot of the same patterns during their pregnancies. Patients who have very extreme nausea, what we have labeled hyperemesis, tend to have it in repeated pregnancies, whereas patients who have less nausea don’t. Our sleep patterns tend to be the same. So yes, I think you can expect the same thing in most of your pregnancies, whether that’s good or bad.

DS: Okay.

SG: Right? But there are things that we can do. I think knowing the signs and symptoms before they occur- many people might think are going to feel like doomsday, like they don’t want the negativity. But in fact, I think you and I agree as practitioners that if we teach people ahead of time, they’re then they’re not blindsided by them and they can even take measures into their own hands beforehand.

DS: Exactly.

SG: To just feel a little bit calmer. Yeah.

DS: And that’s how I always talk about once the baby comes, too, or babies like to be proactive to know what it’s going to look like, how are you going to deal with it? I’m a huge fan of that.

SG: Yeah.

DS: Let’s talk about ways that we can maybe maximize sleep quality in the more basic of ways initially. Are there behaviors that you recommend to your patients? Daytime behaviors versus nighttime?

SG: We talk about that term sleep hygiene, which I always laugh. To me, those terms are wonderful because they can help describe two people in general, pregnant people or regular people. How they should try to strategize their evening routine.

But I really always want to be ginger in how I describe that to patients, in that I don’t want to put pressure on them. I mean, you think about it, you and I, I’m a doctor. I run in from home. I’m often just seeing patients or I’m on call. I, you know, have to be with my kids. I have to, like, answer emails. I’m not supposed to perform those anti-hygiene techniques like having my phone in my room, having the lights on, being really stimulated. And yet, I can’t live that way.

So, to the masses, I would say, of course, we know that we should not have our phone on, ideally in bed, or even within that, like, 30 to 60 minutes before we’re going to go to sleep because of the stimulation from the light. We should try to have dimmer lights. We should ideally not have caffeine after 2 to 4 p. m., depending on how your body reacts to it. Alcohol, which you shouldn’t be drinking in pregnancy anyway, is certainly a no no, but absolutely for sleep it disorders it even more.

On the flip side, things like, I would normally tell my gynecology patients to try to restrict their liquids after, you know, 4 to 6 p. m. if they can, so that they don’t have to wake up frequently in the middle of the night. Because that can often lead to disordered sleep in the post menopausal patient, for example. But in a pregnant woman, I don’t really want her to restrict her liquids, because if she’s restricting fluids, especially water, that might actually increase her risk of a urinary tract infection, or of feeling contractions, what we call Braxton Hicks, or those false labor contractions.

So again, I think we have to dip our toe gently by saying, drink a lot, but try to restrict it. Not right before you, you know, try not to drink it too much before you go to sleep, but at the same time, make sure that you’re hydrated well.

DS: Yeah.

SG: Right? And so we find ourselves speaking out of both sides of our mouth a little bit and just accepting that some of these things are going to be challenging to do.

DS: Yeah. No, that makes total sense. I think even with restricting liquids, people who are pregnant are still going to wake up to urinate regardless a lot of the times.

SG: Yes. Right?

DS: Now, what about activity levels? You know, we talk a lot about activity and I always say like, your body is like a battery that’s recharging at night and if you don’t use it during the day, you’re not going to need to sleep as much at night.

SG: Yeah.

DS: How do you talk about activity throughout the nine months and potentially changing?

SG: Increased physical activity during the day is absolutely not only important for our metabolism, in pregnancy, it decreases the rate at which we gain weight, which also decreases high blood pressure, diabetes. So those are really valuable, and it seems like it exhausts us in a healthy way, so that we will sleep in a more ordered way at night, which is amazing.

That said, patients also have trouble exercising too much because of the aches and pains and all those things that we’ll talk about again in the third trimester. One little bit of research I found that I don’t know how you feel about this or if you found anything that supports this, typically during the day, naps are a little bit controversial, right?

Sometimes people over-nap and that means they can’t sleep at night, but maybe there’s a sweet spot of just the right amount.

DS: Yep.

SG: We really do know that sleep in general is so important for our brain function and certainly to grow a healthy human. And so the data that I found was that sleeping less than about five hours of night is really not great for pregnancy in particular and increases the rate maybe of preterm labor, preeclampsia, things that we know, right?

Because that’s going to increase our cortisol levels – our stress . But it seemed that while most of the time we’re told by sleep doctors that we can’t kind of bank our sleep and make up for it by napping, maybe in pregnancy that’s a little bit different.

DS: Yeah.

SG: And that was an interesting concept to me. Now, the truth is, most of us, either because we work or we have children at home, are not able to nap very well. But I do tell my pregnant patients, like, this is not the time to be completely, like, your most productive self. You’re already being productive by growing a human. And potentially doing whatever work outside the home you have to do. So if you have the opportunity to sleep next to your toddler, please go take a nap. Like anytime you can, close your eyes and take a nap.

DS: Yeah.

SG: So I don’t know how you feel about that data, but I thought that was actually fascinating because it seemed to fly in the face of the other data that we used to.

DS: I mean, it really varies based on, like you said, there’s no like hard and fast rules. It really, when pregnancy happens, you have to really, kind of, modify things. So if someone is not bothered by their nighttime sleep being more disrupted, and they’re okay with a nap and that’s enough to get them through the day, it’s not my place to say don’t do this anymore. If they’re really struggling, they can’t get that nap routinely, or they’re struggling even with the nap to get enough energy throughout the day, and their sleep is really disrupted at night, and they’re getting far less sleep than they really should be, then we might start talking about the timing of the nap, the length of the nap. What time of day is it happening?

SG: Yes.

DS: Something that I struggle with once in a while is the caffeine intake with some patients. So there are some patients who are just really sleepy during the day and can’t take that nap and they’re wondering about caffeine. Like how would you talk about that with your patients?

SG: I mean, the good news is I feel like I can talk about caffeine more easily with my pregnant patients than with my non-pregnant patients.

DS: Interesting.

SG: Because non-pregnant patients, it seems like everyone’s tolerance for caffeine is a little bit different.

DS: Yeah.

SG: Certainly as a post menopausal woman, my tolerance for caffeine is less than what it was before. But in pregnancy, we know that 200 milligrams of caffeine, or less. There’s a couple of data points that would maybe say 300 milligrams.

But in general, we accept that about 200 milligrams of caffeine or less is what we should be drinking outside of her sleep, but for things like risk of miscarriage and other aspects of pregnancy, like hypertension. So the good news, I can say to patients 200 milligrams or less, which is essentially like one cup of coffee, right? Like one latte or one cup of coffee. And honestly, most patients are doing that in the morning. I don’t want people to suddenly quit their caffeine, which many women do, because then what happens is they get these rebound headaches. And they find themselves chasing the headache with Tylenol, which can be very safe.

I’d rather them have a cup of coffee than, unfortunately, you know, be debilitated by the headache or have to take medication to fix the headache that they could have fixed with a safe amount of caffeine.

DS: Excellent point.

SG: But you and I know that it’s better to do it earlier in the day, of course.

DS: It is, and that being said, you know, I think people just, it’s also the routine of I’m going to get up in the morning and make my coffee. Like I do that myself.

SG: Of course.

DS: But I think too, if you’re someone who, we try to limit it eight-ish hours before bed. If you’re someone who notices that the morning is not so much of a challenging time, but the early afternoon, that post lunch dip is a problem, then maybe have a cup of coffee at, like, 11 o’clock in the morning.

Don’t have it right at the beginning so that then it might help carry you a little bit in the afternoon if you’re not able to take that nap. So it’s okay to have that cough, but maybe think about the timing of it, that sounds like.

SG: Yes.

DS: And what about foods? When I was pregnant, I woke up with that heartburn constantly and the reflex until I talked to my doctor about it, and they were like, take this.

SG: Take this. Yeah.

DS: But are there foods, things that you recommend just like cutting out altogether or positions to sleep in to help with that?

SG: Food is a very… I’m probably going to overuse the word triggering during our discussion today, but food is very triggering, right? Because on one hand, we have patients who really do need to be instructed and taught and encouraged to not gain too much weight during pregnancy. Because we know that excessive weight gain, which has plagued me my entire life, that really can increase the risk again of gestational diabetes, preterm labor, challenging delivery, increasing the chance of a C section, you know, preeclampsia-

DS: Apnea.

SG: Apnea, which also just leads to disordered sleep. So all these things. That said, the pressure on women, societally, is so immense, and now we have women who are, we’re exhausted, we’re working, we don’t have maternity leave, you know, we have a toddler at home, and now you have a doctor being like, you shouldn’t be eating this, and I think we have to be very constructive in how we discuss it, and not just formulaic.

All that said, yes, of course, I try to encourage people to not gain excessive weight, for all the reasons that we discussed, and I do think that patients know what is causing their heartburn. And so, certainly, the obvious things, like deep fried foods, all those fatty foods that people are eating certainly can cause more heartburn.

And for some people, a lot of the spicy foods and things like garlic and onions, they don’t need to suffer. I don’t want them to suffer because the medications that we get really are very safe. So people can take the chewable antacids. They’re not often very effective. So many times they have to switch to the oral antacids that are very safe to take.

And again, there’s no need to suffer. And my argument to patients in support of taking these medications is, don’t be a martyr and think you’re doing yourself a favor by holding off on the medicine and suffering through heartburn, because then it’s going to lead to disordered sleep. And you actually really need the sleep more than anything else.

Not as a luxury, as you and I know, but really to help your health. So I really implore people, of course, you and I will both say, listen to your doctor and ask your doctor, but your doctor should be telling you, take the antacid if you need it.

DS: I was in that boat. I remember I was having such horrible heartburn and I was now sleeping, I remember, I was like propping myself up when I was sleeping and I was limiting certain foods and nothing was working. And it was like I couldn’t even sleep on my side when I was propped up so much. Then I finally talked to my doctor and she’s like, you’re fine to take something. I was finally able to sleep again. And that was a game changer in my third trimester. So thank you for mentioning that.

SG: Yeah. I think sometimes as doctors we’ll say things like you’re fine to take it, but we say it as if, you’re fine if you need it. That doesn’t mean that that’s what we’re actually saying, but that’s how it comes across to the patient. So they will find themselves holding back and suffering.

So I actually always try to really say to my patients, if it’s going to help you, I’m going to tell you that I’m instructing you as the doctor to take it. Because if I just say it’s fine, you’re going to think that you’re like, you know, being a wimp by treating your reflux or your lack of sleep. Whereas I’m telling you, medically, you need to treat those things because it will be better for you and the baby. And I know that that sounds funny, but I think people need to hear that because all too often they think they’re harming someone by taking something when in fact, I don’t want to go so far as to say it will harm them, but it can harm them more by lacking sleep.

DS: That’s a game changer. I really do think the way that things are presented and the way that we speak about it makes a huge difference in the language. So it takes that shame away and that guilt aspect. That’s huge.

SG: Yeah.

DS: So speaking of like the positions, like, how do you recommend, like, we can talk about pillows, but are there other things that you recommend positions people sleep in when they’re pregnant? What do you do when someone’s like, I just can’t get comfortable?

SG: Two things. I mean, you touched upon it. The pillow really is amazing. I mean, my business partner in Tribe Called V, I will never forget the day she called and she was like, I found the holy grail of pillows, which they didn’t even exist when I had my last one, 13 and a half years ago, I don’t think or certainly I didn’t get it.

DS: Yeah.

SG: But that huge pillow that wraps around your body, goes in between your knees. I mean, that really, truly, can be a game changer. And I hate saying that because I think from a place of privilege for many of us, it’s like, oh, I’ll just buy another pillow. And for other people, it’s not that easy, but you can certainly create that same situation by propping a pillow, a blanket. Towels in between your knees, prop up the side. We know that in theory, we should all be sleeping on our left side during pregnancy. That said, I’m also very cautious about saying to patients that while I have to cover myself, and go by the party line that you should be sleeping on your left side. But the honest answer is if you’re sleeping a little bit on your back and you are not short of breath.

DS: Yeah.

SG: And your legs are not numb. Then that means if those far away organs are getting blood supply, then most likely the uterus and the baby are getting some blood supply too. But at some point during your pregnancy, most of us will feel short of breath, heartburn, and our legs will go a little bit numb, and that’s a sign that we should not be sleeping flat on our back or on our right side if that’s what’s affecting us. So not only pillows, but you touched upon it, sitting in a recliner or sitting and, like ,sleeping kind of upright. It’s so uncomfortable, but it might be the only way.

DS: Yeah.

SG: Because then you’re not compressing your big vessels, your vena cava and your aorta, and causing that shortness of breath and the numbness. You’re not harming the pregnancy in any way and you’re able to kind of sleep. But the key is switching positions frequently, right? Because you think you’re comfortable, and within an hour and a half you find yourself having to flip over.

DS: Yeah.

SG: It’s the other reason that I am actually a pretty big proponent and advocate, not of wanting to over medicate anything in medicine or over medicate pregnancy certainly, but Doxylamine, the over the counter sleeping tablet that in America is Unisom brand.

DS: Yep.

SG: The generic is Doxylamine. What’s really important to know is that the other generic of it is the gel cap version, which is actually Benadryl, which is a different medication than the Doxylamine. But I really feel strongly that patients need to know that that is actually the one medication prospectively studied in pregnancy that has not been shown to cause any harm. And so they can really safely take that and they might need to, to our point before. So while sleep positions are really important, you might find that you have to sleep in a recliner or with something between your legs.

You still wake up uncomfortable, but at least if you take a half a tablet or a tablet to get you through the night, you’ll still wake up to pee because we haven’t even talked about the peeing yet. But at least you’ll be able to fall back asleep. And that’s really important because what you don’t want is laying in bed with your mind racing, which is what tends to happen to most of us. That 3 a. m. wake up, your mind is racing, you can’t fall back asleep.

DS: And I think too, the medication is one option, and I think people are always so skittish about it, for sure. And we also have research, there’s not tons, but we have more and more research showing that CBT for insomnia that goes beyond just the sleep hygiene stuff.

So that’s when I might talk about napping strategies and limiting time in bed and working on worries about sleep. So it could be a combination, which I’ve done with many people, you know, patients.

SG: Yes.

DS: Would be medication once in a while if they don’t want to use it nightly and really trying CBT first.

SG: Yeah.

DS: But the thing is, CBT doesn’t work immediately. Right? And when you’re pregnant, you only have so many weeks.

SG: And you have to really practice it. Well, and just so everyone knows, because I had mentioned CBT to someone and they were like, really? I can take CBD.

DS: Oh yeah.

SG: I was like, no, no, no, no, no. CBD you should not be taking in pregnancy. We don’t have great data, but the data we have is you should not be taking it.

DS: Yeah.

SG: CBT, Cognitive Behavioral Therapy, I actually, well, and I want us to talk about magnesium.

DS: Oh yeah.

SG: But I don’t know if you’ve ever taken Transcendental Meditation, but TM is a very specific type of meditation where they give you your own mantra.

DS: Yeah.

SG: And most of my patients just don’t really have the time or the energy to go take the four sessions. It’s a very discreet, easy class to take, but it still costs money and it’s time. So I’ve actually encouraged a lot of my patients. to make up a two syllable word.

DS: Yep.

SG: And right before they go to sleep, put that in their mind and repeat it over and over. And the minute they wake up at three in the morning, repeat that word over and over, because I think it really just detaches their brainwaves.

DS: Yes.

SG: And so while the physiology of sleep during pregnancy is still going to be somewhat disordered, but at least if you wake up, to go pee, you’ll be able to come back and fall asleep more easily than what usually happens, which is your brain engaging.

And I have to tell you, my patients who have listened and done it, it’s really a game changer for them. It’s what’s helped me sleep as a postmenopausal patient.

DS: Because what you’re doing is giving them essentially a mindfulness exercise to focus on.

SG: Yeah.

DS: And when you’re doing mindfulness, if other things come into your mind, you’re letting them go to get back on the exercise in front of you. Any way you want to do it. And I love that idea. And we don’t want people necessarily suffering needlessly, but also being, like you were saying, to be realistic that you might still have to get up to urinate. You’re going to have to do these things and it’s not going to be perfect, but you shouldn’t be suffering with, like, three hours a night, which so many women are, they’re just up ruminating.

SG: And again, you shouldn’t be suffering, not because we care emotionally about it, but you shouldn’t be suffering because it is not good for the pregnancy. So that that helps convince you, that’s what you should do.

DS: Exactly. So that being said, what do you make of the mindset of fear during pregnancy, right? Like some people, I get patients who are in their first trimester who are terrified of not sleeping, but they don’t want to take medication. They want to do CBT, but they’re so fearful of that lack of sleep influencing the pregnancy. Like, how do you deal with that with patients when they come in? Because the fear is making them sleep worse too.

SG: I think there is fear across the spectrum of being a woman.

DS: Yeah.

SG: Right? We are fearful constantly. We’re fearful when we’re young that we’re going to get pregnant. Then we’re fearful that we’re not going to get pregnant. Then we’re fearful that we’re going to miscarry. Then once we’re done with pregnancy, we’re fearful of all the other things, you know, our abnormal mammograms.

And so I really try to dissuade the language of fear. I’m often saying to my patients who probably internally roll their eyes, but I say, fear should be reserved for when we’re being chased by an animal in the wild. That is when we need to trigger our fight or flight and use the word fear or I’m scared.

I think it’s very natural and appropriate to voice our anxieties about things like, I’m worried I’m not going to sleep because sleep is really essential and I like it. And I think that’s very valid.

DS: Yeah.

SG: But I think that’s very different than saying I’m just so scared. Right. And so I really do try across the board when people talk to me about their fears, I think many people want to believe like, it’s just language, it’s not a big deal, but these languages are a big deal. You and I know that when we trigger fight or flight and use words like I’m fearful, I’m scared, that triggers our cortisol level. Cortisol is not a great hormone for stress, obviously, and it’s not a great hormone for sleep because it leads to more disorder.

So I think really explaining to patients that it’s very natural to have some level of disordered sleep.

DS: Yeah.

SG: That helping heartburn, helping leg cramps, which again we can touch upon magnesium in a second, getting a better sleep pillow or something that’s going to prop between your knees, drinking enough water that you’re hydrated, but not overdoing it with all kinds of liquids, especially caffeine.

I think kind of strategizing that and making it clear that we will be able to help them get through the pregnancy with CBT, maybe a little bit of mindset modeling on their own with regard to how they feel. Maybe a little bit of pharmaceutical aids with over the counter, safe antihistamines like Doxylamine. Again, not to mention one of my favorites, which is magnesium, no joke.

DS: So let’s talk about this. So there’s a difference too between leg cramps, nocturnal leg cramps, and restless legs. So restless leg, I’ve had both of them. I don’t know, you were saying that the leg cramps you’ve experienced. So restless leg is that feeling as the night gets closer, you have this kind of like antsy, you got to keep stretching. And I still have that even to this day.

So that’s one thing. And then we often see in people with cramps at night, we see restless leg. And so you can also get nocturnal leg cramps. So let’s talk about the role of magnesium and that stuff. And also with just the calming aspect, it can help to kind of relax you a bit.

SG: Exactly. Well, this is why I always joke, and I’m sure that like the actual pharmaceutical companies who sell magnesium wouldn’t like that I’m – they would love it and they would not like it that I’m saying all these things because again, are they actually indicated for all of this? Who knows? But I will tell you that anecdotally, most of my patients agree that when they take magnesium, and there’s a lot of different types of magnesium, but when they take magnesium, it helps with anxiety, sleeping, leg cramps, and constipation, not to mention headaches.

And to be fair, all of us in pregnancy have at least four out of five. I’d say not everyone gets headaches, but almost everyone gets constipated because the progesterone is slowing our bowels. We almost all get, as we talked about, some level of anxiety and lack of sleep. And, I wouldn’t say all of us, but the vast majority of us have these leg cramps.

And the leg cramp, as you and I know, is the muscle in the leg. And sometimes it’s not just the leg, it could be your abdominal wall, it could be your feet, sometimes even your hands. Those muscles contract. And so that muscle is constantly contracted and it leads to the most inexplicable pain.

DS: Horrible.

SG: And magnesium really seems to fix that along, we think, with hydration and maybe stretching. The majority of my patients at some point in their pregnancy are instructed by me to take magnesium.

DS: Okay.

SG: Whether it’s because of the anxiety sleep or the leg cramps, or the leg cramps affecting their anxiety and sleep.

DS: What about like magnesium? There’s like creams, all this stuff. Do you ever recommend that?

SG: Yeah.

DS: Okay.

SG: You know, I don’t as much and I’ll tell you why. But mostly because those aren’t going to necessarily help with constipation. We don’t think because it’s not getting systemic. I have had patients who said, well, I like the spray on my pillow or the cream and I think if you like it, and it works or taking an Epsom salt bath because that’s also magnesium.

I think any of those strategies you like you might as well. What I found is that again, because it’s anxiety, sleep, leg cramps, and pooping, why not take one, one that’s going to fix all of those.

DS: I love that.

SG: And it really, it can help vitamin D absorption. So there’s so many benefits to magnesium, and there’s really very little risk. In the obstetric world, we use IV magnesium. when someone is at the hospital to prevent preterm labor if someone’s in imminent preterm labor and to actually, well, and that’s a longer story as to how it actually works and whether or not it actually works and to help decrease the risk of seizures from preeclampsia.

So we have a lot of established safety data with magnesium. So again, hands down, I would say that certainly over even sleeping, the sleeping medications that we talked about over the counter, but it can be really a game changer.

DS: That’s great. What about with the restless legs? So I know when I had it initially, I was talking to my OB and we did a blood panel, it turns out that I was pretty iron deficient. So do you recommend that? Then you talk about the constipation, like all that from the iron.

SG: Well, and that’s the thing. So it’s interesting you say that. Restless leg, which seems to be a little bit less common than the leg cramps. Again, anecdotally, restless leg, like you touched upon can often be from iron deficiency. Or some women, their iron shows up normal, meaning their hemoglobin will look normal when, when their general blood count is checked. Their iron might even look normal, but their iron stores, their ferritin is very low. And that’s not something we standardly check in pregnancy or otherwise.

And so that can be a reason if someone has restless leg where they feel that kind of jittery shaking, I will always check their iron stores and their ferritin level. I actually would rather us replete at a, higher level than what is recommended. We actually don’t encourage iron unless, the threshold is 10.5 in your hemoglobin. That’s actually quite low as you and I know. And so the reason most of us don’t is because that’s the guideline and we don’t want to cause constipation. But I always say to my patients, I’m going to be a little bit mean here. I’d rather you actually take the iron, be constipated and then use the strategies that we can to decrease constipation, for example, magnesium, because you’ll feel better.

You’ll actually overall just have more energy, which will probably lead to better sleep and certainly less chance of bleeding when you’re actually delivering, less chance of postpartum depression. So iron itself doesn’t have a direct effect on sleep, but certainly indirectly can help so many other functions of your body that it would indirectly help with sleep as well.

DS: Once I helped the restless legs, I was actually able to finally fall asleep.

So let’s talk about partners and how if you have a partner who wants to offer support or even a larger network of like friends, family, what are some good answers, if they do ask, like, how can I help you? If you’re not sleeping well, like what would you, maybe offer for them to say?

SG: Oh my gosh, doc, I’m only laughing because if anyone saw my face, if they’re watching any clip of this, when you said partners immediately my face went to like, I’m rolling my eyes because I thought you were going down the road of what about if you have a partner in particular, maybe a male partner who’s snoring?

DS: Oh, well yeah.

SG: So you might be able to fall asleep. And then you got the person snoring there that even the earplugs doesn’t … And so I’m just going to say this. There is no shame in going to separate rooms if you need to during pregnancy, especially because sleep is of such paramount importance.

So tell them to muffle it. Tell them to go in another room. You should have access to the most comfortable bed because your sleep really is important for you and for the baby.

That said for the partners who are offering their services and help I mean the truth is that’s a really hard one because I think of course they could be the ones to make sure they don’t keep the light on next to you. Don’t keep the TV on help with your sleep hygiene, you know, bring you a cup of we didn’t touch upon herbal teas, but maybe bring you a cup of, like, mint tea for example. Do the things they can to try to decrease your stimulation so that you can sleep better. But the honest answer is none of us really want someone policing us.

So the last thing I would want is for the partner to say, like, what can I do to help? And then you to say, well, tell me not to have my caffeine at 3 p.m. And all of a sudden they’re, you know, watching over you.

DS: Yeah.

SG: So it’s a hard one. I mean, I don’t, I’ve never come up with, I would love to hear what you say is there, are there any great strategies you can think of for partners to help in sleep in general? But for not snoring, not keeping the lights on, not keeping the television on.

DS: Yeah.

SG: Right?

DS: I think whatever you can do to help maximize the chance of you sleeping, whatever they can do to help would be ideal. But the other thing, I feel like even things that are, you might be a lighter sleeper, I know in my third trimester I was a super light sleeper.

So I remember asking my husband when his alarm had to go off in the morning, I could get up a little later. I had him get a vibrating alarm clock. So something that went under his pillow. Like things like that to help with it and then sleeping apart.

And then one thing to add to that is other children. So maybe getting some help with other kids around the house so you can take that nap if you need to.

SG: Yeah.

DS: Maybe you switch up bedtime routines so that you can get some time to rest. So thinking about sharing the load a little bit more if you haven’t been. And then the one thing I was going to say too, on top of that, is that you were talking about the snoring partner.

When you’re pregnant, the risk of sleep apnea can increase a lot. And so that’s something, if you’re the person who’s starting to find that you’re snoring, pauses in breathing, bring that up to your doctor. Yeah?

SG: Yeah. You might be the snoring partner who is waking yourself up. You might be the snoring partner waking your snoring partner up. Although I find that like, even when I snore during my pregnancy, it did not seem to be waking up my snoring husband. He was like, oh, I don’t know. But yes, to your point, you should bring that up with your doctor. I mean, we haven’t yet gotten kind of sophisticated enough to do aggressive sleep testing during pregnancy and offering CPAP and things like that.

But I wonder now with all of these new devices, if that’s the next wave where we really are going to kind of attach more importance to that during pregnancy, I mean, one way around that, as you and I talked about, is sleeping a little bit more propped up.

DS: Yeah.

SG: Maybe sleeping in, if you have access to a recliner, or at least pillows underneath, just to not have that pressure.

DS: Yeah. I mean, I think that it’s a real access to quick care. I mean, I’m lucky if I have a patient who’s pregnant, I suspect apnea, I can call, you know, a colleague of mine and get them in faster, but that doesn’t work that way for many people. And some of the great sleep centers around here, even if you’re just not even going to a whole sleep center, you just want a home sleep center, it can take sometimes one, two, three months. That’s not helpful.

So we need to get people, like you said, access to care. We need to get them faster treatment or at least get them evaluated first properly.

What do you think in the last few minutes we have? What do you think people misunderstand or forget to take into account in general when it comes to women’s health and reproductive health?

SG: I will tell you what I think women forget most. I think that women, and I don’t even know that we forget it, I think women have bared the burden that has been foisted upon us by society, but unfortunately we have, not readily, but we have taken it on and not given it back. We have bared the burden of guilt, guilt and shame and fear and cloaking things in secrecy.

So all at once we don’t talk openly about our periods. We don’t talk openly about how deeply uncomfortable it is to be pregnant. We don’t want to come across as whiny or complaining. We want to show that we’re just as strong as men, which by the way, we clearly are because we’re doing everything they do, while we’re growing humans, while we’re menstruating once a month, while we’re becoming menopausal.

DS: Yes.

SG: I really wish for us as women that we could all at once speak, like I said, more openly, frequently, casually about all of these to really highlight it, make it a very clear, normal part of our world without normalizing the pathological side of it, like terrible periods terrible pregnancies.

DS: Yeah.

SG: And really make it clear that we need not help in the way that makes us feel helpless or weaker. But we need a collaborative effort. Because this is how people were supposed to actually grow humans, right? Pregnancy and being a person, we were supposed to do this together. And instead we’ve taken on the burden.

So that’s just one of many things that I think really needs to change in medicine and in society. But again, I say to women all the time, I hear women use the term guilt so much. I heard the baby cry at 3 a.m. And I was so tired. I didn’t want to get up. And my husband got up and I feel so guilty.

To which I’m like, I’m confused. Did you, as I always say, knowingly, willfully inflict harm on someone? If not, why would you feel guilty? You actually honored yourself and therefore helped grow a healthy baby. And your husband was then able to attend to your child and create a bond with your child. Why do we allow ourselves consistently to feel guilty? And that’s something that is on us. We have to do better. I hope we can encourage that in womanhood.

DS: Dr. Shieva, we love to end each episode with a segment we call Something to Sleep On. One last piece of advice for anyone looking to change their sleep habits specifically. So when it comes to pregnancy and sleep, do you have any one final thought for listeners?

Something to really sleep on, besides what you just talked about, which was amazing, like getting help and not feeling guilty about it.

Dr. Shieva: Yeah. Okay. I mean, I’m going to give you two. These are really concrete. It’s two, concrete, it’s what we talked about. Magnesium and get yourself in a good sleep position. Those two. Yeah.

DS: I think magnesium doesn’t get spoken about enough. I mean, I think people think it’s this cure all for insomnia a lot of times. It’s not. But in pregnancy and with the leg cramps and all the other stuff, I think it really can be a game changer for people.

SG: It can help so much. Absolutely.

DS: Thank you. So Dr. Shieva, thank you so much for joining us. I really, really appreciate it. I learned tons during this episode and I had an absolute blast, really. So I know our listeners are going to enjoy it too. So thank you so much.

SG: Well, thank you, it was so fun to be here.

DS: Thanks for listening to Sleep Talking with Dr. Shelby, a Sleepopolis original podcast.

Remember, if you’re tired of hitting the snooze button, make sure to hit that subscribe button right now in YouTube, Apple podcasts. Spotify or wherever you’re listening and for even more sleep tips visit sleepopolis. com and my Instagram page at sleepdocshelby.

Today’s episode was produced and edited by Freddie Beckley.

Our Senior Director of Content is Alanna Nuñez. Our Head of Content is Molly Stout and I’m Dr. Shelby Harris. Until next time, sleep well.