As a psychiatrist, Sonia Welch knows that poor sleep can affect health.
And that's where her own tale of sleeping woes begins.
Before pregnancy, she was a stomach sleeper with no history of sleep disorders. But for obvious plumped-up reasons, tummy sleeping isn't feasible during pregnancy.
The psychiatrist at Mon Yough Community Services in McKeesport began sleeping on her side only to experience hip pain. For an hour or two each night, she would lie awake or resort to reading to induce sleep. As can happen during pregnancy, she also developed acid reflux.
"I was eating Tums like a truck driver," said Dr. Welch, 35, who moved from Stanton Heights to Ross over the weekend. "It was really rough. I would be exhausted in the morning."
As it turns out, a good night's sleep is a key to good health, especially for proper immune function. So it's common sense that a pregnant mother requires sound sleep to maintain her and her unborn baby's health.
"Most health care providers don't ask pregnant women about their sleep, as it is thought to be a normal part of being pregnant," said Louise M. O'Brien, a sleep specialist and associate professor of neurology in the University of Michigan Health System. "Research is now showing us that several sleep problems, such as frequent snoring, poor sleep quality, short sleep duration and maternal sleep position may all be associated with poor outcomes in mothers as well as babies.
"These outcomes include such things as high blood pressure, gestational diabetes, depressive symptoms and cesarean section in mothers and growth restriction, preterm birth and stillbirth in babies."
Improving sleep quality might lessen the impact, she said.
Two University of Pittsburgh studies, which analyzed the impact of disturbed sleep on the immune system, are putting science to the common sense. Both studies show that poor or insufficient sleep leads to an unnecessary immune response resulting in inflammation, which can lead to a higher risk of such adverse outcomes as babies born prematurely and babies born with a low birth weight.
A 2009 Pitt study raised speculation that persistent sleep disruption in the first 20 weeks of pregnancy produced inflammation levels that may affect the remodeling of maternal blood vessels. If they are unable to develop fully, those blood vessels could fail to provide enough blood flow and thus nutrition to the placenta and fetus.
"Poor health behaviors such as smoking, alcohol consumption and obesity, along with other neurological and hormonal alterations, may also contribute to sleep disruption and possibly increased inflammation," the study said.
The latest of the two studies, published online on July 15 in Psychosomatic Medicine, found that women with depression face a double whammy. Depression already involves excess inflammation. That coupled with disrupted sleep -- both lead to a higher concentration of inflammatory cytokines in the blood -- can raise the risk even higher for problems for mom and baby.
Michele Okun, who holds a Ph.D. in health psychology and serves as assistant professor of nursing and psychology at the Pitt School of Nursing, was involved in both Pitt studies that focused on the health impact of increased concentration of cytokines during pregnancy. Cytokines, immune-system inflammation proteins, are produced in higher concentrations as a result of poor sleep and leaves a woman with increased levels of inflammation.
Previous studies had shown that persistent inflammation, without an infection to fight, can damage health and even lead to chronic disease. Studies also have established that high concentrations of inflammatory cytokines exist in women who had such adverse pregnancy outcomes as pre-eclampsia, intrauterine growth restrictions and preterm birth.
A direct link has not yet been established between the higher concentration of cytokines and problems in pregnancies.
"We suggest that behavioral processes such as disturbed sleep may play a role in adverse pregnancy outcomes, given the relationship between sleep disturbance and inflammation, and inflammation and adverse outcomes," the recent Pitt study states.
Focused on sleep disorders and depression, the study involved 168 pregnant women, age 15 to 44, all in the first 20 weeks of pregnancy. Each woman was assessed at 20, 30 and 36 weeks' gestation. They were divided into different groups, including ones suffering from depression and those without depression, and those with and without disrupted sleep patterns. Delivery time and birth weights were recorded, among other information, along with cytokine concentrations in the women's blood.
The study showed a greater risk of poor pregnancy outcomes for the women who got fewer than seven hours of sleep, especially when it involved insomnia, disruptions or sleep fragmentation. Lack of sleep alone increases cytokine concentrations. Anxiety from an inability to sleep, which can cause higher cytokine concentrations, also can make it more difficult to get quality shut-eye.
"Stress comes in many forms," Ms. Okun said. "There's psychological and physiological stress. People don't eat well enough or exercise, so there are downstream effects on other behaviors that we know are not good for early pregnancy."
When a woman becomes pregnant, her immune system normally scales back -- a process known as down-regulation -- to prevent it from attacking the foreign tissue of the fetus. That can leave a woman vulnerable to infection, she said.
"We contend that sleep is a relevant behavior to consider during pregnancy because it is a modifiable behavior that, when optimized, can have considerable benefits on health-related outcomes."
Until recent years, sleep disruptions and shortened sleep duration were thought to be a normal part of pregnancy.
"Now we see that it has an impact on mom and baby," said Judette Louis, director of research in the University of South Florida obstetrics-gynecology department. "Once sleep is disrupted, you see abnormalities that have an impact on health. You see more diabetes, more preterm birth and low-weight babies."
Research focus has turned to understanding how inflammation leads to health problems in pregnancy -- specifically how sleep disorders cause bodily changes, leading to adverse outcomes -- and studying the long-term consequences on mom and child.
"Things that happen in the uterus during pregnancy predict what happens later in life," Dr. Louis said. "There has been a significant amount of research that mom's habits or things mom consumes may predict whether asthma or immune problems will occur or early onset of high blood pressure or diabetes."
The quality of sleep alters during pregnancy for obvious reasons.
Her center of gravity changes progressively. She now has a larger, heavier belly that puts undue pressure on the spine if she tries sleeping on her back. It sags at an angle to the mattress when she's on her side. Certain muscles experience uncomfortable pressure never experienced before. Her hips are changing, leaving more space between the knees. Folded towels and pillows become necessary to provide support and comfort.
There's even speculation from an evolutionary point of view that sleep disruptions during pregnancy help prepare the mother for sleep disruption once the baby arrives.
Expect disruptions throughout the night due to a more frequent need to urinate and a difficulty in shifting positions. But Dr. Louis said women should strive to get a total of seven to nine hours of sleep each night. Total sleeping time is more important than the number of disruptions.
"You can't control how often the baby moves or how often you have to go to the bathroom," she said. "But you need to have a total amount of sleep through the night so the body can restore itself."
Ms. Okun said mothers should work to improve sleep habits with stress reduction techniques and mild sleep medications deemed safe during pregnancy. Her other advice: Do not watch television in bed. Get plenty of bright light during the day then dim the lights in the evening to get one's circadian rhythms in sync so the body produces sufficient melatonin, which induces sleep. Use yoga and exercise to reduce stress. Camomile tea and a hot bath are calming.
Don't take stress to bed.
Serious sleep disorders should be discussed with a physician and resolved, if possible, even if it means seeing a sleep specialist, she said.
"Sleep helps with body, tissue and cellular repair and good immune function," Ms. Okun said. "Anyone without sufficient sleep is disrupting the body's ability to repair itself on a daily basis."
Psychiatry vs. pregnancy
Even a pregnant psychiatrist can have problems sleeping.
"The severity of my sleep disruption was low compared to other women," Dr. Welch said. "I tried to lower stress levels because I know that high stress is not good for the baby."
On July 12, 2012, Dr. Welch gave birth to her daughter, Elena, who was breech and delivered by cesarean section. She weighed 6 pounds, 15 ounces -- a healthy weight. The University of Maryland Medical Center says most babies weigh 6 to 8 pounds with 5 pounds, 5 ounces and lower representing a low birth weight.
While Elena generally is healthy, Dr. Welch said, she has developed nystagmus, a disorder sometimes called "dancing eye" that causes fast, involuntary eye movements that can adversely affect vision.
"For a mom, it's easy to blame yourself," she said. "I don't have any doubt about the potential risk of poor sleep. Mommy always wonders if it is something she did or didn't do. Sleep is a vital experience, and we in medicine don't yet understand the full importance of sleep. We just know it is important."
David Templeton: email@example.com or 412-263-1578.