5 Simple Tips for Better Pregnancy Sleep

1. Minimise the Blues

We know all know that too much screen time is not a good thing (aside from the fact that we’re slowly becoming social zombies in our own home). But did you know that it’s the blue light emitted from our smart phones, laptops and TV’s that suppress the release of sleep-inducing melatonin and increases levels of wakening cortisol? The term ‘tired but wired’ can be used to sum this concept up perfectly – although we’re tired, we just can’t seem to fall asleep at bedtime especially after we’ve been watching a movie or scrolling through Instagram before bed. Increased exposure to blue wavelength light – which is great during the day if you want to increase concentration and mood – affects our circadian rhythms and prevents us from naturally winding down and becoming physiologically ready for bed if we get too much after sunset (when we naturally start releasing melatonin and decreasing levels of cortisol).

Unfortunately, most of our evening routines these days include watching Netflix series on TV, answering emails on the laptop or mobile or checking our Facebook feed, often in bed. Maybe it's not just a coincidence that sleep issues have also risen in the last few years as technology has become ever more prevalent and pervasive in our daily lives. We get that our phones have become an integral part of our society but taking a screen-time break 1-2 hours before bed can make a world of difference to improving your sleep quality.

If you can’t give up your electronic devices just yet, at very least use or install a blue light filter on your mobile and laptop that automatically turns on at sunset. Try f.lux for laptops and Twilight for Android and other mobiles. Apple phones have an in-built setting called Night Shift that you can turn on (they won’t let you install external blue light filters). You’ll quickly get used to the slightly red hue on your devices and will be shocked by the brightness of a normal screen after a few days.

2. Get Your P’s Right.

Ah, the joys of growing a human. If the morning sickness didn’t get you, then the difficulties of finding a comfortable position for your increasing bump definitely will. You can't lie on your stomach anymore, lying on your back causes reflux, and wasn’t there a side you shouldn’t sleep on as the baby gets bigger?

Our secret to sleeping better during pregnancy: Pillows, and the more the merrier. Normal ones, long ones, fat ones, skinny ones – find ones that suits your body and bed. Then use them for optimal positioning during the night.

-        Support your head: Propping your head up slightly on two flatter pillows can help to reduce reflux related to pregnancy. You can easily slip one out when you turn on your side to keep your neck in a more optimal neutral position, helping to prevent neck pain and stiffness.

-        Under the knees: For mama’s experiencing lower back pain* (who doesn’t?), slipping a pillow under the back of your knees when lying on your back is a well-known physio ‘hack’. What it does is takes your lumbar spine slightly out of extension, reducing the compression in your lower discs and aligning your spine more optimally in the supine position. A medium thickness pillow, long roll or bolster works well for this trick.

-        Between your knees: Sleeping on your side can often increase sacro-iliac/pelvic pain* that commonly occurs during pregnancy. Putting a medium thickness pillow between your knees keeps your pelvis in a more neutral position which supports your joints and ligaments and can help reduce discomfort during the night. This tip often feels more comfortable even for people without pelvic joint issues. And the side you’re supposed to sleep on during pregnancy? Experts recommend sleeping on your left side from the second trimester onwards as it may improve circulation and blood flow to your foetus (the inferior vena cava, the major vessel bringing blood to baby from your heart, is on right side of your spine). Lying on your left side may also help improve constipation and elimination as it follows the natural direction of your digestive system: waste products travel through your large intestine starting from the lower right of your abdomen, up, across to the left then back down.

-        Behind your back: Adding an extra pillow behind your back when lying on your side can help you from rolling onto your back and better support you during the night. This mini barrier between you and your partner can also prevent you being kicked or nudged accidentally during the night - NOT what you want when your sleep is already interrupted by other factors (We still love you baby daddies and second mamas!)

That said, finding the optimal position that suits YOU is the most important factor, so that you can grab as much of those precious sleep minutes as you can. Sleep is key to recovery, healing and regenerating, all of which can make the difference during this important phase of your (and your baby's) life. During the later stages of my pregnancy, I was able to sleep on my right side and back for some of the night with no issues and often found them more comfortable – listen to your body and find what works best.

*If you’re experiencing issues with pelvic or other pains that simple positioning doesn’t help, then a visit to a physiotherapist who has a holistic understanding of pregnancy bodies is highly recommended. We can assess and treat the underlying issues that may be contributing so that you can be more comfortable, stronger and better able to enjoy this wonderful time!

3. Drop an F-bomb before bed.

Eating too close to bedtime, especially if you’re experiencing the joys of morning sickness that actually spans the whole day, can leave you feeling overfull and experiencing reflux at night, partly due to the growing human you have inside of you pressing up against your diaphragm.

Conversely, being hungry, or eating the wrong thing (yes, I’m talking to you ½ a block of Cadbury’s chocolate), can also leave you experiencing blood sugar drops during the night that wake you up at 1am for no apparent reason, in addition to your already increased number of toilet calls.

Having what’s lovingly referred to as a ‘fat bomb’ by Keto-fans shortly before bed can be a godsend in sending you off deeply into Slumberland without the extra wake-ups. A small bedtime snack of fat – a scoop of peanut butter, a piece of cheese, or a home-made mixture of cacao butter, coconut oil and nuts, helps your blood glucose levels remain stable over night as well as taking the edge of any hunger and cravings.

Fat is the only macronutrient that has no effect on your blood glucose levels and is essential to feeling satiety. Still attached to idea that fat is bad? That old tale has been debunked years ago (1). If that’s still not enough to convince you, then remember that fat is essential (yes, you read that right, you NEED it during pregnancy) for optimal development of your baby’s cell membranes and brain especially the frontal lobes responsible for executive & higher function. No fat = poor baby brain function and ain’t nobody that wants that.

4. The Magic M.

If we had to pick one sleep-soothing nutrient, it would be magnesium. Most of us are sadly deficient in this key mineral essential for over 300 enzymatic reactions in the body including energy production, DNA replication, insulin sensitivity, muscle function and protein formation (2). Low levels can cause muscle tension, cramping, restless legs, anxiety, insomnia and irritability… did someone say typical pregnancy symptoms?

Magnesium can be found in dark leafy greens (if you can stomach them!), seeds and nuts, legumes, dairy products, meat, unprocessed grains and chocolate (careful having too much before bed due to the stimulating effects of caffeine-containing cocoa and sugar causing late night blood glucose drops). Increasing your intake of some of these foods can be beneficial as well as being natural and in the form your body best knows how to process. There are also many supplements on the market but be aware that just like anything, not all supplements are created equal. Supplements utilising the citrate or orotate form of magnesium can have a stimulating effect on your bowels if taken in excess (not a bad thing if pregnancy constipation is raining on your parade though). For those wanting to avoid a possible laxative effect, look for a glycinate or chelate form, which are specially formulated to be more bioavailable to your body without having the concomitant effects on your bowel.

Keep in mind that with any supplement, talking to a qualified nutritionist or practitioner is best practice so that you can be advised on the best supplement for your body and condition, and so you’re not just getting ‘expensive urine’ (aka spending lots of money on supps but getting none of the benefits).

Another method of getting more magnesium that's perfect for a bedtime routine is having an Epsom salt (magnesium sulphate) whole-body or footbath. Magnesium is well absorbed transdermally ie. through the skin, especially in areas where you have many sweat glands and hair follicles (3). The soles of your feet, palms and armpits are where the majority of your sweat glands are found for example, making a foot bath an ideal solution for those not wanting, or who don’t have access or time to, a full-sized bath. It can also be the better solution for pregnant mama’s who are often advised not to spend prolonged periods in a hot bath to avoid raising a foetus’s temperature too high.

Soaking your feet in a small tub (I’ve used a mega-sized protein powder bucket in the past!) filled with warm water and ¼ -1/2 cup of Epsom salts for 20 -30 minutes can be a relaxing part of your new bedtime routine. Add in soothing music, and your fat bomb with a cup of herbal tea, and you’ll be blissed out and ready for bed in no time. Maybe something for partner to prepare?

5. Nurture Your Gut & Microbiome

Most of us these days are aware of the importance of gut health and a balanced microbiome (ie. the good and bad bacteria in your gut) on digestive issues and immunity. Some people also know about the importance of a mother’s microbiome on her child’s microbiome and their immune system and ability to fight off infection (that’s a whole other topic). But few realise that optimal gut health is a key factor in helping you sleep better, especially during pregnancy.

Remember the sleep-essential hormone, melatonin, that we need to be able to fall asleep? It’s made from another hormone called serotonin, and both are produced and found in highest quantities in our gut – yes, you read that right, our gut, not our brain or anywhere else in our body. One study reported 400 times more melatonin present in our intestinal lining compared to the brain (4) – affected primarily by food intake and fasting, not our natural circadian rhythm. Low or insufficient levels of these hormones can influence mood, conditions such as depression and anxiety which can disrupt our sleep, as well as directly impacting on our sleep ability (5). And if the health of our gut and microbiome are not optimal, then production and utilisation of these key hormones is also going to be compromised.

If you have digestive issues, bloating or pain related to certain foods, inconsistent bowel movements, history of antibiotic use or a known gastrointestinal issue such as Irritable Bowel Syndrome (IBS), Small Intestinal Bacterial Overgrowth (SIBO), then your poor-quality sleep may be related to these issues. Contacting a functional medicine practitioner or nutritionist who can properly assess and provide you with a customised treatment plan is recommended.

Bonus tip: Another Magic M

There’s good reason for all the hype about mindfulness, meditation and getting your Om on. Numerous studies have shown that meditation has a positive effect on managing stress and anxiety (6,7)

Many of us find it is the mental-emotional aspect of ourselves that refuses to let us sleep restfully at night and meditation is powerfully effective at helping us to better manage anxiety, worry and that mind that just won’t stop. Whether you use a guided meditation, simple background music, focussed breathing techniques or repeating a mantra or sound, anything that causes you to stop and observe your thoughts, rather than simply allowing them to over-run you, will be beneficial  to helping you sleep – especially during pregnancy, when our minds are often filled with other worries and concerns about parenting and what to expect.

Remember if feelings of anxiety and worry are starting to become a regular occurrence, it may be time to reach out to someone as post-natal depression can actually start during pregnancy. The Edinburgh Post-Natal Edinburgh Scale is a short self-report measure used to screen women for signs of emotional distress during this period (8). Please note that it is not to be used for diagnosis so if you have any concerns, contact a suitably qualified health professional.

Whatever you choose to do, committing to a regular bedtime routine plus a few sleep-inducing tricks is key to restful pregnancy sleep.

Soothing all aspects of body, mind and soul to get you into a relaxed, less stressful state may also help baby down the track; studies have shown that high levels of stress and anxiety during pregnancy are associated with lower cognitive scores, social/emotional and behavioural issues in infancy (9, 10)

All the more reason to get your good sleep on :)

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References

1.     Bjarnadottir, A. (2016). 5 Studies on Saturated Fat — Time to Retire the Myth?. [online] Healthline. Available at: https://www.healthline.com/nutrition/5-studies-on-saturated-fat [Accessed 10 May 2019].

2.     Osiecki, H. (2010). The Nutrient Bible (9th ed.). Eagle Farm: BioConcepts Publishing.

3.     Gröber, U., Werner, T., Vormann, J., & Kisters, K. (2017). Myth or Reality-Transdermal Magnesium?. Nutrients, 9(8), 813. doi:10.3390/nu9080813

4.     Bubenik G.A. (2002). Gastrointestinal melatonin: localization, function, and clinical relevance. Dig Dis Sci. 47(10):2336-48. 55. Rice J, Mayor J, Tucker HA, Bielski R

5.     Li, Y., Hao, Y., Fan, F., & Zhang, B. (2018). The Role of Microbiome in Insomnia, Circadian Disturbance and Depression. Frontiers in psychiatry, 9, 669. doi:10.3389/fpsyt.2018.00669

6.     Chen, K. W., Berger, C. C., Manheimer, E., Forde, D., Magidson, J., Dachman, L., & Lejuez, C. W. (2012). Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depression and anxiety, 29(7), 545–562. doi:10.1002/da.21964

7.     Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., … Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA internal medicine, 174(3), 357–368. doi:10.1001/jamainternmed.2013.13018

8.    Blackdoginstitute.org.au. (n.d.). [online] Available at: https://www.blackdoginstitute.org.au/docs/default-source/psychological-toolkit/edinburgh-postnatal-depression-scale.pdf?sfvrsn=8 [Accessed 14 May 2019].

9. O'Connor, T. G., Caprariello, P., Blackmore, E. R., Gregory, A. M., Glover, V., Fleming, P., ALSPAC Study Team (2006). Prenatal mood disturbance predicts sleep problems in infancy and toddlerhood. Early human development, 83(7), 451-8.

10.     Talge, N. M., Neal, C. , Glover, V. and , (2007), Antenatal maternal stress and long‐term effects on child neurodevelopment: how and why?. Journal of Child Psychology and Psychiatry, 48: 245-261. doi:10.1111/j.1469-7610.2006.01714.x

How to Squat (and a Simple Trick to Squat Better!)

Squatting is an essential part of our day to day life and not just relegated to the gymspace of bodybuilders and Crossfitters. Think about it: every time you sit on the toilet, get in and out of a chair or car or crouch down to pick something off the floor you're using a squat pattern, so being able to squat well, and without pain, is important for all of us, everyday and at all ages of life. Squatting is also a useful movement during late pregnancy and labour to help prepare us for birth, as well as a great movement for those with pelvic floor issues.

So what went wrong with that squat?

From top to bottom :

1. Lateral weight-shift to right (see unevenness in dowel height)

2. Loss of core activation (see pouchy tummy bulge)

3. Medial deviation of knees (see them coming towards the middle)

4. Over-pronation of ankles, right worse than left (see how the inner arches of the feet have collapsed)

Hmm, so what caused what?

There are a few possibilities:

• Ankle pronation causes medial deviation of the knees

• Weightshift to one side is usually a sign of moving away from a current or previous pain/injury

• Knees collapsing in can be due to weak gluteus medius/minimus, tight tensor fascia latae (TFL) or just badly taught technique or poor body awareness

• Tight calves or restricted ankle joint mobility will restrict dorsiflexion which causes someone to squat in this way just so they can get 'butt to ground'

Ultimately though, point number 2 is usually the root cause of most of these postural issues - a poorly activating, dysfunctional core.

Why? Without the ability to stabilise from the core out, we can't transmit/dissipate forces on our bodies optimally. Because our bodies tend to obey what we tell them without regard for how, compensations and deviations occur to let us move.

Trick Your Squat

Using a Theraband above the knees is a simple and easy 'hack' to help improve this commonly seen squat posture. It gives you tactile feedback to activate your glutes as you work to stop the band pulling your knees inwards. Switching on your side glutes will often also correct arch collapse and increase stability around the hip, pelvis and lower back which is important in being able to perform this move.

Identifying and correcting a possible pain source that the patient may be avoiding, differentiating between calf muscle tightness or ankle joint stiffness then treating the correct deficit appropriately, teaching correct squat posture and improving postural awareness are all essential (and something we can help you with here).

Above all, we need to address that pouchy tummy and poorly activating core with cues, well-taught corrective exercise... and by not allowing our clients (or ourselves!) to continue squatting with poor form!!

For those that want more and like to watch rather than read, see this vid I did on squatting here.