sleep disturbances

Mamas on Bedrest: When Your Legs Won’t Rest

June 17th, 2013

Restless Leg Syndrome, involuntary twitching and tingling in the legs, can be a problem during pregnancy and a particular problem for Mamas on Bedrest. The increased weight as a result of pregnancy and the increased stress on the circulatory system are the major reasons that the symptoms occur. Restless Leg Syndrome is primarily relieved by changing positions and/or getting up and moving around-both options that are limited or non-existent for Mamas on Bedrest. Conditions such as pregnancy induced hypertension and pre-eclampsia often require that Mamas on Bedrest lay on their left sides to increase blood flow back to the heart from the lower extremities, relieving stress on the circulatory system. With this requirement, leg discomfort may be exacerbated with few options for relief. Restless Leg Syndrome can progress and become quite uncomfortable, limiting Mamas’ ability to rest. So how can Mamas on Bedrest manage this non-life-threatening but very annoying problem?

Massage. As previously stated in other posts, prenatal massage is an excellent way for mamas to relax tired, aching muscles during pregnancy. Because of the additional weight, mamas’ bodies shift to accommodate the weight and as a result, the musculoskeletal system shifts out of alignment creating stress on muscles, ligaments and tendons. Prenatal massage therapists are able to rub and soothe these tired, achy tissues and relieve tension, fatigue and pain.

Relaxation. Meditation, hypnosis and deep breathing can also help relieve the symptoms of restless leg syndrome. Calming the nervous system, relaxing the mind and relieving worry, stress and anxiety often relieve the tingling and twitching associated with restless leg syndrome.

Support your legs. Adequate support and positioning will go far to relieve leg pain and restless leg syndrome.  A Must have for Mamas on Bedrest is a Body Pillow, and positioning that pillow to properly support and align Mama’s body is essential. View our video on pillow positioning for a better bed rest.

Stretch. As previously stated, movement is essential to helping relieve symptoms of restless leg syndrome, yet movement for Mamas on Bedrest is limited. There are several simple stretches that mamas can do while on bed rest and we provide them on our free video channel for easy access.

Water. One reason that leg cramps and other symptoms of restless leg syndrome occur is due to dehydration. Adequate water intake is a must for all pregnant women, but especially for pregnant women with restless leg syndrome. Adequate hydration ensures that circulation flows that muscles and soft tissues are well lubricated and that muscle wastes are properly flushed away. But staying hydrated can present an additional problem for Mamas on Bedrest in that the increased fluid intake will result in increased urination. Many mamas try to limit fluid intake which only increases leg cramps, symptoms of restless leg syndrome and can increase the risk of developing a urinary tract infection. Its a delicate balance, but mamas, be sure to drink plenty of water while on bed rest.

Vitamins and Minerals. Most pregnant women are prescribed prenatal vitamins, but many of these vitamins only provide the minimum amounts of vital nutrients necessary to sustain pregnancy and mama and baby may need more. There have recently been several studies and articles published documenting the functional amounts of vitamins and nutrients that are needed to ensure that mama is getting all that she needs to remain healthy, for healthy development of the fetus and to sustain the pregnancy. Mamas with restless leg syndrome may be low on potassium or calcium. While it is not advised that mamas take mega doses of vitamins, ensuring that there is adequate, functional levels of vitamins and minerals will help prevent some of the twitching and discomfort of restless leg syndrome. In addition to prenatal vitamins, mamas may want to add or increase bananas-a good source of potassium-and calcium fortified orange juice and green leafy vegetable (also good sources of calcium) to their diets.

Restless Leg Syndrome can be an annoyance, but it needn’t incapacitate Mamas on Bedrest. Implementing the few tips above can go along way to relief and a bed rest free from leg cramps, twitching and tingling. 

 

Mamas on Bedrest & Beyond would like to thank Tammy Mahan, a contributing writer to Healthline.com, for sharing the perils and pearls of Restless Leg Syndrome with us.

Mamas on Bedrest: Biological Aspects of Post Partum Depression-Part II

December 17th, 2012

In our last post, we learned that there are specific physical changes that occur in pregnancy that put women at risk for Post Partum Depression (PPD). In most women, these changes self correct in the post partum period. However, for many women, re-regulation does not take place. And in women with susceptible anatomy, these changes put them at increased risk of developing Post Partum Depression. Below, we share information from a recent publication that discusses how the changes that occur as a natural course of pregnancy can contribute to a woman developing PPD.

Changes in Post Partum Depression

Endocrine

Low levels of estrogen and progesterone have been shown to be associated with PPD, but cannot be said to be causative as there have been studies in which participants had elevated levels of estrogen and/or progesterone and had PPD. However, estrogen therapy-in relatively large doses-does seem to improve PPD.

PPD being linked to suppression of the HPA has been substantiated in several studies. Women with PPD have markedly suppressed HPA and their HPA’s don’t return to their baseline regulation as does those of women not subject to PPD.

Oxytocin, the milk let down hormone, seems to have a positive mood altering effect. However, when women have difficulty with breastfeeding or stop breastfeeding, they often are at increased risk for developing PPD. This point remains controversial as some women, it seems, stop breastfeeding because they are depressed. Oxytocin does seem to have a suppressive effect on the HPA

As previously stated, Serotonin seems to play a prominent role in PPD.  Low levels of serotonin are indicative of depression and medications that increase serotonin levels (SSRI’s) successfully treat PPD. Other neurochemicals and neurogenetic predispositions that influence the serotonin levels, typically suppression of serotonin production and release, further put women with these chemical anomalies or genetic predispositions are at increased risk for developing PPD.

Seasonal/circadian Changes

Newer research in PPD shows that there are seasonal effects, i.e. PPD may in fact be more prevalent in the fall and winter months, as SAD.

High morning levels of Melatonin are associated with PPD. Melatonin is made from serotonin but when secreted in the morning, when one is to awaken instead of at night when one is trying to sleep, increases sleep deprivation and sleep deprivation is a hallmark of PPD. Unfortunately, sleep disturbances are also a hallmark of the early post partum period, so it is often hard to discern if the Melatonin levels are abnormal due to depression or due to post partum sleep disturbances. For now, studies suggest that high am blood levels of Melatonin are present in women with PPD. More work in this area is forthcoming.

Immunologic Changes

Inflammation plays a roll in PPD. As previously stated, cortisol levels are increased during pregnancy (due to the maternal/fetal interaction) and the feedback loop telling the adrenals that there is enough cortisol is shut down. Without the adrenals functioning, at delivery, cortisol levels drop and the inflammatory response is left unchecked. Increases in inflammation is the result of a prolonged inflammatory response which has been shown to be a way for PPD to develop.

Thyroid Disease

Abnormal thyroid function appears to be associated with increased psychiatric symptoms, with hyperthyroidism being related to anxiety, mania, restlessness, depression and cognitive deficits and hypothyroidism is associated with memory deficits, lack of concentration, psychomotor slowing and depression.

Pregnancy in and of itself challenges normal thyroid function, often resulting in the presence of thyroid antibodies. During pregnancy TSH levels fluctuate depending on the stage of pregnancy while levels of T3 and T4 remain relatively stable within normal limits. In the early post partum, TSH levels are decreased. Of note, thyroid hormone replacement in the post partum doesn’t seem to prevent or reduce PPD symptoms in the presence of thyroid antibodies.  Currently, these authors are only able to report that

Women with maternity blues have higher TSH levels  and women with higher, albeit still normal, TSH levels (measured 4 weeks after delivery) tended to have higher depression scores at 4-weeks postpartum.  In addition, the authors reported a positive association between subclinical hypothyroidism at delivery and the development of self-reported depressive symptoms at 6 months post partum.

Given this information, the best thing to do in a woman with PPD symptoms would be to test for thyroid function and treat accordingly.

Other Potential Factors in PPD

Vitamin D. It seems that Vitamin D is being found to affect everything from our moods to our weights and everything in between, so it’s no surprise that it has an effect on PPD. What is surprising is that fact that recent studies have reported associations between vitamin D deficiency, inflammatory response and mood disorders.

As it relates to PPD, the authors note that Vitamin D levels have been found in postpartum women compared with pregnant women, but there is  so far only one study in the literature, examining serum 25(OH)D levels postpartum in relation to Edinburgh Postpartum Depression Scale scores. That particular study shows a significant association over time between low 25(OH)D levels and high depression scores postpartum. Thus far, only one randomized clinical trial has evaluated treatment with high doses of vitamin D in depressed subjects with promising results.

Leptin

Although Leptin is most closely associated with satiety and obesity research, recent research has linked leptin with depression and reproductive function in women. Leptin is reported to rise during pregnancy, fall after delivery and subsequently increase during the first 6-months postpartum. A study by these authors showed that higher leptin levels at delivery provided protection against depressive symptoms at 5-days, 6-weeks and 6-months post partum. Several theories are suggested for the protection, but to date, there is no definitive explanation.

This is a very interesting and important article. This level of indepth research is much needed if we are ever to be able to effectively treat (and perhaps even prevent) PPD. As these authors showed, there are multiple mechanisms potentially responsible for post partum depression. It is no longer enough to “poo poo” it away as mood, fatigue, being a new mommy or to ignore the signs and symptoms all together. Each and every pregnant and post partum patient should be routinely asked if they have any signs or symptoms of mood changes, and prompt and aggressive evaluation and treatment should be undertaken to ensure that mamas in need, receive the help and care necessary.

Reference

Alkistis Skalkidou, Charlotte Hellgren, Erika Comasco, Sara Sylvén & Inger Sundström Poromaa. Biological aspects of postpartum depression. Women’s Health, November 2012, Vol. 8, No. 6, Pages 659-671.  DOI 10.2217/whe.12.55 (doi:10.2217/whe.12.55)

Mamas on Bedrest: Help With Sleep Disturbances During Pregnancy

March 5th, 2012

Sleep is an essential component of well-being whether pregnant or not. Sleep deficit or deprivation can have serious deleterious effects on health and has been shown to be a risk factor for preterm labor. Bedrest Coach Darline Turner-Lee, coping with sleep disturbances of her own, shares tips so that Mamas on Bedrest can get a good night’s sleep.