Clinical Scenario

I just found out that I am pregnant, and I am so tired that I am falling asleep at my desk during the day. Is this normal?

Q. What is excessive daytime sleepiness?

A. Excessive daytime sleepiness is beyond and sometimes different than the sensation of feeling tired. People may experience a need for longer sleep at night, may start to require a midday nap, or experience an irresistible urge to sleep during the day. When the need to sleep exceeds nine hours per night or impacts day-to-day activities, this is viewed as abnormally high levels of sleepiness, known as “excessive daytime sleepiness”.

Q. Does pregnancy cause or worsen excessive daytime sleepiness?

A. During pregnancy there are many physical and hormonal changes and psychological factors that can affect night sleep duration and quality, making night sleep less restorative, and increasing sleepiness during the day. Please see the Sleep during Pregnancy health topic for an overview. In pregnancy, higher progesterone levels and β-HCG in the first trimester can cause people to feel sleepier during the day. In fact, some notice this as one of the first signs of pregnancy. This daytime sleepiness usually improves after the first three months, though can worsen again in the third trimester when physical changes impact nighttime sleep quality.

Q. How can excessive daytime sleepiness be managed during pregnancy?

A. If the daytime sleepiness is so strong that it is impacting the day-to-day activities or causing safety issues (such as sleepiness while driving), it is important to talk to a healthcare provider to see if there are other factors or conditions causing the excessive daytime sleepiness.

Some ways to help manage excessive daytime sleepiness include:

• improving the duration of night sleep. This can be done by going to bed earlier or waking up later. Simply increasing nighttime sleep by 30-60 minutes can sometimes help substantially.
• improving the quality of night sleep, to get the most benefit possible from sleep. See Sleep during Pregnancy for more tips.
• adding a planned nap in the early afternoon can also help. The nap should not be too long (preferably no more than 30-40 minutes) or too late in the day, so it does not cause nighttime sleep to be disrupted
• maintaining energy levels by staying well hydrated, getting regular exercise, and eating regularly
• having a glass of water or getting outside for a short walk when feeling sleepy during the day
• when feeling particularly sleepy, avoid activities such as driving. If excess sleepiness is a problem while driving, immediately pull over to rest.  Ask for a ride from a friend or family member.

Please see the Sleep during Pregnancy health topic for additional tips on improving sleep.