Managing Stress and Sleep Before, During, & After Pregnancy

Let’s start with SLEEP.

Sleep is an important modifiable lifestyle factor impacting preconception, pregnancy, and postpartum. Even just a few nights of sleep disturbances (read: terrible rest, fragmented sleep, insomnia, restless leg syndrome) interferes with hormone production and stress responses, which can play out in conception and/or pregnancy. The same hormones involved in regulating the sleep-wake cycle (cortisol and melatonin) are also involved in reproduction. It’s all connected!

BREAKING SLEEP DOWN, STAGE BY STAGE

FERTILITY

Most of the research on 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, many pathways by which sleep disturbances impact 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 health, it plays a pivotal role in fertility and supporting a healthy pregnancy, especially in the earliest days after conception. Research has found links between increased levels of thyroid stimulating hormone (TSH) and women who are sleep deprived, impacting the ability of our body to support a healthy pregnancy (3, 4). Furthermore, sleep disturbances can disrupt follicle-stimulating hormone (FSH) and progesterone levels, which are essential to ovarian function. One study revealed that women who slept less (short sleepers) had 20% lower FSH levels than those who slept more (long sleepers, averaging more than 8 hours per night). Progesterone is related to luteal function and helps support implantation and healthy pregnancy, making low levels concerning to healthcare practitioners (3).

Sleep deprivation may also trigger inflammatory responses in the body, making it difficult for the body to support its free radical defenses against oxidation. Assisting the body in maintaining a healthy balance between antioxidants and oxidative stress is valuable for overall health and fertility (remember there is a delicate balance between antioxidants and oxidative stress in the female reproductive system) (5).

PREGNANCY & BIRTH

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

• Maintaining healthy blood sugar levels | Sleep is critical to 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 to late pregnancy, researchers found that sleep disturbances were linked to higher levels of cytokines (messengers from our immune system), which can impact mood and mental resilience (8).
• Labor duration | 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).
• Discomfort during labor | Less sleep before being admitted to the hospital may be linked to more pain and discomfort during labor, according to a study on sleep patterns before birth. (10).

POSTPARTUM

As a new mother, getting a good night's rest can be even more difficult. Decreased estrogen, progesterone, and thyroid hormones can severely impact sleep. These changes and external sleep disruptions from your new baby may also impact your mood, making it nearly impossible to get the rest you need (11, 12). Sleep deprivation can also lead to increased levels of inflammatory markers (13, 14, 15). It’s clear there is a possible relationship between poor sleep quality and postpartum recovery which can lead back into that cruel cycle we talked about 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 quickly. But prolonged or excessive stress can impact both you and baby during pregnancy and postpartum. 

For instance, stress hormones like cortisol, epinephrine, and norepinephrine interact with hormones that directly influence the production of estrogen and progesterone, leading to less and poorer quality sleep.

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 stress) 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 than women with lower levels (16).

PREGNANCY, BIRTH, POSTPARTUM, & BEYOND

Pregnant moms who experience stress are more likely to get sick because their immune system reacts to it (17). Both stress and infection can further impact the immune system during pregnancy (18, 19). Likewise, higher stress hormones can impact labor and contractions (20).

Recent studies suggest that managing mom’s stress can have benefits that span generations, including:

• Increased mental resilience in infants | Exposure in the womb can affect the development of baby’s stress response, impacting their developing nervous system and creating lasting effects on their 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 may promote healthy infant growth and development (25, 26)
• Healthy behavioral development | Emerging preclinical studies in animals have shown that mom’s stress levels impact the development of learning and memory during pregnancy (27)

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 that 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. Limit blue light exposure using blue blockers, orange filters, or 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 promotes relaxation and better manages 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 Nourished Nerves Calming Tonic formula supports the life-changing adjustments that growing and caring for a new baby brings. 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 soothe your nervous system and encourage a sound night's sleep when you need it the most. Ideal for those looking for natural solutions, this organic, botanical-based supplement is easy to incorporate into your routine and uses only five high-quality natural herbs.

Check out these herbs:

Organic Chamomile (Matricaria recutita) is a gentle yet powerful nervine often used to ease tension and invite sleep. Chamomile contains apigenin, an antioxidant that binds to receptors in the brain that may help relax muscles and support healthy and restful sleep. Because of its mild yet sunny disposition, chamomile combined with ginger and lemon balm is also good at nourishing healthy digestion.*

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, with recent clinical studies suggesting it may support 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 encourage 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 exceptionally rich in silica, calcium, chromium, and magnesium.

Organic Ginger (Zingiber officinale) supports digestion but 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.