Health and well-being, as well as physical and cognitive functioning, can be severely compromised by poor sleep and chronic sleep loss.

Most women's sleep loss is attributable to lifestyle factors such as staying up late to complete house-hold responsibilities, caring for young or elderly family members, or working long hours or at night in healthcare or transportation industries. At other times, women's sleep can be disturbed by an acute or chronic illness. Regardless of whether sleep loss is due to lifestyle factors or chronic illness, this loss affects all aspects of health, including fat and glucose metabolism, inflammatory processes, learning and cognitive functioning, social relationships, job performance, mental health and mood state, and overall quality of life.1

Although a single pregnancy and postpartum period spans only about 2 years in a woman's entire life, sleep disturbance during this reproductive phase can have a major effect on the health of the mother as well as her infant. Beginning early in pregnancy, sleep can be disrupted by urinary frequency, nausea, leg cramps, and other discomforts.2 As pregnancy progresses, risk factors for sleep disorders, such as increased weight and sleep disordered breathing (snoring, sleep apnea),3 or anemia and restless legs syndrome4 become more apparent.

Insufficient sleep during the third trimester may place women at higher risk for longer labors and cesarean births.5 During the third trimester, women typically report 2 to 3 awakenings during the night and about 7.5 hours of sleep, but some report sleeping as little as 3 or 4 hours, particularly if there are other children at home who are not yet sleeping through the night.5,6 With more objective sleep measures, such as wrist actigraphy or polysomnography, pregnant women sleep about 30 minutes less than they subjectively report, and their brief awakenings over the course of the night accumulate to 45 to 60 minutes of lost sleep.5,6 Given this expected sleep loss, difficulty falling asleep is not likely an issue during pregnancy unless there is anxiety or stress associated with the pregnancy, or unless sleep is limited by environmental factors such as noise, light, or bed partner sleep problems. Sleep loss during the early postpartum period makes the entire family more susceptible to the types of hazards of sleep deprivation seen in shift workers.

This special perinatal section primarily focuses on maternal sleep experiences prior to delivery and sleep loss associated with postpartum recovery and maternal mental health. There has been very little research on sleep issues for childbearing women, particularly carefully controlled studies or adequate samples of childbearing women. Past research often failed to consider parity, gestational age, or maternal lifestyle factors such as employment, breast-feeding, or availability of support for infant care during the night. It is hoped that the studies enclosed in the perinatal section of this special issue spotlight the essential sleep needs of new mothers.

Kathryn A. Lee, PhD, RN, CBSM, FAAN

Professor Department of Family Health Care Nursing, School of Nursing University of California, San Francisco

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