We all know that stress can negatively affect the quality and duration of your sleep. Reciprocally, disrupted sleep can increase stress levels. It’s a vicious cycle! The harmonious relationship between sleep, stress, and hormones can be elusive even in the best of times but becomes especially important during preconception, pregnancy, and postpartum. Understanding the impact of stress and sleep on your fertility can help you understand their effects on maternal and fetal health, which might help inspire you to think about more actively managing and improving both!

Let’s start with SLEEP.

Optimizing sleep is an important lifestyle factor that can impact preconception, pregnancy, and postpartum. Even a few nights of sleep dysregulation (read: terrible rest, like fragmented sleep, disturbed sleep, short or long sleep duration) interferes with hormone production and stress responses, which can play out in conception and pregnancy. This is because the same part of the brain that regulates the hormones involved in the sleep-wake cycle (cortisol and melatonin) are also the same hormones involved in reproduction. It’s all connected!

BREAKING SLEEP DOWN, STAGE BY STAGE

FERTILITY

Most of the research around fertility and sleep has been around sleep patterns in shift work or people whose profession has them working unconventional hours overnight or in extreme stretches. However, several pathways by which sleep dysregulation impacts fertility are emerging in the literature, including the direct and indirect impact on hormones (1, 2).

For instance, thyroid function is directly impacted by sleep. If you remember from our most recent article on thyroid optimization, it plays a pivotal role in fertility and supporting a healthy pregnancy, especially in the earliest days after conception. Several studies confirm that thyroid stimulating hormone (TSH) increases significantly in women who are sleep deprived, which can increase the risk of pregnancy loss (3, 4). Furthermore, sleep dysregulation can negatively affect follicle-stimulating hormone (FSH) and progesterone levels, which play an important role in ovarian function. In one study, FSH levels were shown to be 20% lower in women who were short sleepers compared to long sleepers (those who average more than 8 hrs per night). Progesterone is related to luteal function and is necessary for implantation and maintenance of pregnancy, making low levels concerning to health care practitioners (3).

Sleep deprivation may also trigger inflammatory responses in the body, which can affect the immune system. Chemicals produced in the body during inflammation can negatively impact fertility, with one study noting higher levels in women with infertility compared to fertile women (5).

PREGNANCY & BIRTH

During pregnancy, especially during the first trimester, sleep needs increase due to physical discomfort, emotional changes, and hormonal changes. You are, after all, building an entirely new organ for your baby (the placenta). Despite increased needs, however, quality sleep can be difficult. Though it may take some adjustments, good sleep hygiene, adjusting your sleep position, and managing sleep disturbances can support your pregnancy in several ways:

• Maintaining healthy blood sugar levels | Sleep is a critical factor in glucose metabolism. Studies show that both overly long or short sleep duration can impact blood sugar levels in pregnant women, with the risk increasing significantly with more than 10 hours of sleep per night (6, 7).

• Mood support | In a study evaluating sleep duration in mid-late pregnancy, researchers found that sleep disturbances were linked to higher levels of cytokines, which can impact mood and mental resilience.

• Longer labors | Some studies show women averaging less than 6 hours of sleep per night during the last month of pregnancy had significantly longer labor durations (9).

• Exacerbated pain and discomfort during labor | In a small study observing sleep time before birth, researchers observed that less total sleep the night before hospitalization was associated with the elevated perception of pain and discomfort during labor (10).

POSTPARTUM

After pregnancy, women experience a sudden drop in estrogen, progesterone, and thyroid hormones, which can hugely impact sleep. These changes - coupled with external sleep disturbances from your new baby - may affect your mood (11, 12). Sleep deprivation can also lead to increased levels of inflammatory markers (13, 14, 15). There is a possible relationship between poor sleep quality and postpartum recovery, leading back to that cruel cycle we discussed earlier.

Now, let’s hit STRESS. 

Let’s face it. Some stress during pregnancy is natural. There is, after all, a LOT of significant change happening reasonably quickly. But prolonged or excessive stress can have harmful effects on both you and baby during pregnancy that can even carry on later in life. 

For instance, stress hormones like cortisol, epinephrine, and norepinephrine interact with hormones that directly influence the production of estrogen and progesterone, leading to fragmented sleep, decreased slow-wave sleep, and a shortened sleep time.

BREAKING STRESS DOWN, STAGE BY STAGE

FERTILITY

Long durations of stress can impact fertility during menstruation, ovulation, implantation, and placental development. No stage is safe from too much stress. In one study looking at levels of cortisol and alpha-amylase (two known biomarkers of anxiety) the morning after a menstrual cycle, researchers found that women who had high alpha-amylase levels in their saliva were 29% less likely to get pregnant each month and were twice as likely to be diagnosed with infertility than women with lower levels (16).

PREGNANCY, BIRTH, POSTPARTUM, & BEYOND

During pregnancy, stressed mamas are more susceptible to infection and illness due to the immune system's reactionary response to increased stress (17). Both stress and infection can impact the immune system during pregnancy (18, 19). Likewise, higher than normal levels of CRH, a stress hormone produced in reproductive tissues, can impact labor progression and uterine contractions (20).

Recent studies suggest that managing prenatal maternal stress can have benefits that span the generation, including:

• Increased mental resilience in infants | Exposure in utero can affect the development of the baby’s stress response, which can impact the developing nervous system and create lasting effects on behavior and physiology (21, 22). This is of particular interest as studies show that this can be connected to emotional temperament later in life (23, 24)
• Healthy infant growth | Managing stress during pregnancy has been  shown to help promote healthy infant growth and development in animals and humans (25, 26)
• Healthy behavioral development | Animal studies have shown that the development of learning and memory is impacted by prenatal maternal stress (27), promotes calm, relaxation, and encourages sleep.*

Four ways to support sleep & stress in day-to-day life

There’s no magic formula for the right amount of sleep. Still, there are a few simple lifestyle modifications you can implement to optimize & manage stress during preconception, pregnancy, and postpartum.

1. Limit blue light exposure

Blue light from electronics suppresses melatonin, a hormone that helps control the sleep-wake cycle and is necessary to support egg quality, healthy menstrual cycles, and progesterone production. Without adequate melatonin production, egg quality suffers, making achieving pregnancy more difficult. Limit blue light exposure by using blue blockers, orange filters, or orange glasses, OR stop scrolling. :) We’re all guilty.

2. Breathe. No, really, breathe.

Numerous studies have shown that relaxation techniques can effectively calm the nervous system. Progressive Muscle Relaxation (PMR) is a deep relaxation technique that has effectively promoted relaxation and control of stress. The simple practice involves tensing or tightening one muscle group at a time, holding it, and releasing the tension. Box breathing is another technique used to focus on slow, deep breaths, which arouses the parasympathetic system, producing a calming effect in both the mind and the body.

3. Get moderate exercise

Getting enough movement is vital for fertility; however, too much exercise can activate the stress response system. Exercising at a moderate intensity is ideal and pairs well with restorative exercise types of movement like yoga and pilates.

4. Supplementing for less stress and better sleep

FullWell’s new Nourished Nerves formula supports the hormonal shifts, disrupted sleep, and the life-changing adjustments that growing and caring for a new baby bring. I formulated Nourished Nerves especially for women before, during, and after pregnancy, bridging science and nature with my training as a Registered Dietitian and herbalist. Nourished Nerves blends broad-spectrum herbs to support your nervous system when you need it the most. After thorough peer review by top leaders in the field, I’m thrilled to introduce this first-of-its-kind tincture packed with beneficial nervines to soothe the nervous system and encourage quality sleep. Ideal for those looking for natural solutions, this organic, plant-based supplement is easy to incorporate into your routine and uses only five high-quality natural ingredients.

Check out these herbs:

Organic Chamomile (Matricaria recutita) is a gentle yet powerful nervine that promotes calm and relaxation and encourages sleep.*  It contains apigenin, an antioxidant that binds to receptors in your brain that may induce relaxed muscles and support sleep. Because of its mild yet sunny disposition, chamomile combined with ginger and lemon balm is also good at supporting you to have healthy and comfortable digestion during pregnancy.* 

Organic Lemon Balm (Melissa officinalis) is a gentle and calming herb that helps support the nervous system. A member of the mint family, it has been used for centuries to support cognitive function; recent clinical studies have validated its many uses, including its role in supporting mood and general well-being.*

Organic Linden (Tilia spp.) is one of the most gentle nervines and is valued for its sedative properties which can help promote sleep, support mood, and an overall sense of calm.* Studies show that it promotes relaxation by mimicking the activity of gamma-aminobutyric acid (GABA), a neurotransmitter that boosts mood and relaxes the nervous system.

Organic Milky Oat Tops (Avena sativa) are harvested from the same plant that produces oatmeal. This nervine nourishes the nervous system and helps maintain the myelin sheath that covers our nerve fibers. Milky Oat Tops are also rich in silica, calcium, chromium, and magnesium.

Organic Ginger (Zingiber officinale) supports the digestive system, but it is also a versatile herb that warms and supports circulation. Ginger's anti-inflammatory properties help support brain health and function, which includes increasing blood flow to the brain and supporting normal vagus nerve function.

Nourished Nerves can be used by anyone, regardless of sex, gender, or where you are on your fertility journey. By incorporating it into your lifestyle, you’re ensuring you’re doing everything you can to support your fertility and your own mental and physical health and wellbeing.

*The information on this website is provided for educational purposes only and should not be treated as medical advice. FullWell makes no guarantees regarding the information provided or how products may work for any individual. If you suffer from a health condition, you should consult your health care practitioner for medical advice before introducing any new products into your health care regimen. For more information, please read our terms and conditions.

REFERENCES

1. Mahoney, Megan. Shift work, jet lag, and female reproduction. National Library of Medicine - National Center for Biotechnology Information. Web. Published March 2010. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/20224815/.
2. Axelsson, G. Rylander, R. Molin, I. Outcome of pregnancy in relation to irregular and inconvenient work schedules. National Library of Medicine - National Center for Biotechnology Information. Web. Published Jun 1989. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/2818973/.
3. Kloss, Jacqueline D. Perlis, Michael. Zamzow, Jessica. Culnan, Elizabeth. Graciac, Clarisa. Sleep, Sleep Disturbance and Fertility in Women. US National Library of Medicine - National Institutes of Health. Web. Published Oct 2014. Accessed Feb 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402098/.
4. Verma, Indu. Sood, Renuka. Juneja, Sunil. Kaur, Satinder. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. National Library of Medicine - National Center for Biotechnology Information. Web. Published Jan 2012. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/23776802/.
5. Demir, Bulent. Guven, Suleyman. Emine Seda Guvendag Guven. Atamer, Yildiz. Gul, Talip. Serum IL-6 level may have role in the pathophysiology of unexplained infertility.  National Library of Medicine - National Center for Biotechnology Information. Web. Published Oct 2009. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/19706022/#:~:text=Results%3A%20The%20mean%20serum%20IL,alpha%20level%20among%20the%20groups.
6. Latendresse, Gwen. The Interaction Between Chronic Stress and Pregnancy: Preterm Birth from A Biobehavioral Perspective. US National Library of Medicine - National Institutes of Health. Web. Published Mar 2009. Accessed Feb 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2651684/. 
7. Reutrakul, Sirimon. Anothaisintawee, Thunyarat. Herring, Sharon J. Balserak, Bilgay Izci. Marc, Isabelle. Thakkinstian, Ammarin. Short sleep duration and hyperglycemia in pregnancy: Aggregate and individual patient data meta-analysis. National Library of Medicine - National Center for Biotechnology Information. Web. Published Aug 2018. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/29103944/.
8. Jen Chang, Grace W Pien, Stephen P Duntley, George A Macones. Sleep Deprivation during Pregnancy and Maternal and Fetal Outcomes: Is There a Relationship? US National Library of Medicine - National Institutes of Health. Web. Published April 2010. Accessed Feb 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824023/.
9. Lee, Kathryn A. Gay, Caryl L. Sleep in late pregnancy predicts length of labor and type of delivery. National Library of Medicine - National Center for Biotechnology Information. Web. Published Dec 2004. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/15592289/.
10. Beebe, Kathleen R. Lee, Kathryn A. Sleep disturbance in late pregnancy and early labor. National Library of Medicine - National Center for Biotechnology Information. Web. Published Jun 2007. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/17505229/.
11. Kendall-Tackett, Kathleen. A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. National Library of Medicine - National Center for Biotechnology Information. Web. Published Mar 2007. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/17397549/. 
12. Corwin, Elizabeth J. Pajer, Kathleen. The psychoneuroimmunology of postpartum depression. National Library of Medicine - National Center for Biotechnology Information. Web. Published Nov 2008. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/18710365/. 
13. M Irwin, J McClintick, C Costlow, M Fortner, J White, J C Gillin. Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. National Library of Medicine - National Center for Biotechnology Information. Web. Published April 1996. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/8621064/. 
14. Meier-Ewert, Hans K. Ridker, Paul M. Rifai, Nader. Regan, Meredith M. Price, Nick J. Dinges, David F. Mullington, Janet M. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. National Library of Medicine - National Center for Biotechnology Information. Web. Published Feb 2004. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/14975482/.
15. Irwin, Michael R. Wang, Minge. Campomayor, Capella O. Collado-Hidalgo, Alicia. Cole, Steve. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. National Library of Medicine - National Center for Biotechnology Information. Web. Published Sept 2006. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/16983055/. 
16. C D Lynch, R Sundaram, J M Maisog, A M Sweeney, G M Buck Louis. Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study--the LIFE study. National Library of Medicine - National Center for Biotechnology Information. Web. Published May 2014. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/24664130/.
17. Rogers, Lynette K. Velten, Markus. Maternal inflammation, growth retardation, and preterm birth: insights into adult cardiovascular disease. National Library of Medicine - National Center for Biotechnology Information. Web. Published Sept 2011. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/21821056/. 
18. Thornton, Catherine A. Immunology of pregnancy. National Library of Medicine - National Center for Biotechnology Information. Web. Published Aug 2010. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/20576205/. 
19. Parker, Victoria J. Douglas, Alison J. Stress in early pregnancy: maternal neuro-endocrine-immune responses and effects. National Library of Medicine - National Center for Biotechnology Information. Web. Published May 2010. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/20079933/. 
20. Thompson, Murray. The Effects of Placental Corticotrophin Releasing Hormone on the Physiology and Psychology of the Pregnant Woman. Current Women`s Health Reviews. PDF. Published 2008. Accessed Feb 2022. https://www.eurekaselect.com/article/28540. 
21. Poggi Davis, Elysia. Glynn, Laura M. Waffarn, Feizal. Sandman, Curt A. Prenatal maternal stress programs infant stress regulation. National Library of Medicine - National Center for Biotechnology Information. Web. Published Feb 2011. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/20854366/. 
22. Meaney, Michael J. Szyf, Moshe. Seckl, Jonathan R. Epigenetic mechanisms of perinatal programming of hypothalamic-pituitary-adrenal function and health. National Library of Medicine - National Center for Biotechnology Information. Web. Published July 2007. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/17544850/. 
23. Grant, Kerry-Ann. McMahon, Catherine. Austin, Marie-Paule. Reilly, Nicole. Leader, Leo. Ali, Sinan. Maternal prenatal anxiety, postnatal caregiving and infants' cortisol responses to the still-face procedure. National Library of Medicine - National Center for Biotechnology Information. Web. Published Dec 2009. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/19739133/. 
24. M R Gunnar, F L Porter, C M Wolf, J Rigatuso, M C Larson. Neonatal stress reactivity: predictions to later emotional temperament. National Library of Medicine - National Center for Biotechnology Information. Web. Published Feb 1995. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/7497818/. 
25. Swolin-Eide, Diana. Nilsson, Cecilia. Holmäng, Agneta. Ohlsson, Claes. Prenatal exposure to IL-1beta results in disturbed skeletal growth in adult rat offspring. National Library of Medicine - National Center for Biotechnology Information. Web. Published April 2004. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/14739369/. 
26. Romo, Agustín. Carceller, Raquel. Tobajas, Javier. Intrauterine growth retardation (IUGR): epidemiology and etiology. National Library of Medicine - National Center for Biotechnology Information. Web. Published Feb 2009. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/19404231/. 
27. Yu-jie Li, Li-ping Yang, Jun-lin Hou, Xin-min Li, Lei Chen, Jiang-hui Zhu, Qi-yang Wang, Gai Li, Pei-yuan Zhao, Xi-hong Liu, Zhan-jiang Shi. Prenatal Stress Impairs Postnatal Learning and Memory Development via Disturbance of the cGMP–PKG Pathway and Oxidative Phosphorylation in the Hippocampus of Rats. US National Library of Medicine - National Institutes of Health. Web. Published Sept 2020. Accessed Feb 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509422/. 
28. C Flanigan, A Sheikh, A DunnGalvin, B K Brew, C Almqvist, B I Nwaru. Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: A systematic review and meta-analysis. National Library of Medicine - National Center for Biotechnology Information. Web. Published April 2018. Accessed Feb 2022. https://pubmed.ncbi.nlm.nih.gov/29331049/.