by Dr. Michele Brown, OB/GYN
As the morning sunlight streams in your bedroom window, you open your eyes and stretch your arms toward the light with happiness. You are pregnant!
Your next thought is of the wonderful man lying next to you who made this all possible. You turn to admire his handsome, sleeping face but… where the heck is he?
You find him on the living room sofa, covered with his own clothes, fast asleep. As he wakes, he smiles and fibs to you. "No honey, you were not snoring. I just couldn't sleep and didn't want to wake you." But the truth is in his eyes. You were snoring. Again.
In our society, snoring is either a dark, embarrassing secret, the subject of jokes on late night TV, or both.
But, as far as I'm concerned, snoring is not funny nor should it be taken lightly, especially in pregnancy. Why? Because snoring could easily be indicative of something not right with your pregnancy, and perhaps something that could, and should, be easily remedied.
Sleep complaints are common in pregnancy. Many anatomical, physiological, and hormonal changes occur during these nine months that can contribute to these sleep difficulties and snoring is one of the most common, and often the most annoying, problem.
Pregnancy snoring is caused by factors that lead to upper airway obstruction causing audible sounds. The elevated hormonal increases of estrogen and progesterone can cause congestion and edema leading to nasal obstruction which manifests as snoring. The upper displacement of the diaphragm by the gravid (pregnant) abdomen is one reason. Increases in fluid volume can cause swollen nasal passages, adding to breathing difficulty at night.
About one quarter of all pregnant women snore, especially during the second and third trimester of pregnancy. It is estimated that only 4% of these women snored before becoming pregnant. Habitual snoring is defined as snoring at least, but often more than 3 nights per week.
Studies have found that habitual snoring is associated with other health related complications in pregnancy. Listed among the complications are:
Large weight gain during pregnancy, obesity prior to the pregnancy and/or history of asthma, are all predisposing factors for developing snoring in pregnancy.
Several suggestions that can relieve snoring include:
Caregivers should ask pregnant women during their routine prenatal visits about their sleep and snoring patterns. Pregnant women who habitually snore should be considered higher risk pregnancies and carefully monitored for complications. Recommended glucose evaluations, ultrasounds, Doppler flow studies, non-stress testing, and fetal kick counts, allow the clinician to detect many of the associated complications.
If sleep apnea is suspected, referral to a sleep center for evaluation is warranted. Pulse oximetry and overnight polysomnography are testing that can be performed to detect sleep apnea. Because of the association of snoring and sleep apnea with hypertension and metabolic syndrome, patients should be followed after delivery for evidence of arterial hypertension and coronary artery disease later on in life.