Is CPAP Safe For Mom-To-Be? How Sleep Apnea & Pregnancy Coexist

Pregnancy is complicated. Sleep disruption—and the associated cardiovascular effects of not getting enough oxygen—also progresses with your baby. Meanwhile, the prevalence of a sleep disorder in pregnant women is very high, so it’s only natural for anyone trying to get pregnant to wonder how obstructive sleep apnea (OSA) and pregnancy coexist. Aeroflow Sleep (and Aeroflow Breastpumps) explores this medical intersection, plus what’s happening with your body and why ignoring your OSA risk factors can seriously harm your and your baby’s health.

Like gestational diabetes, gestational obstructive sleep apnea (OSA) is a sleep disorder that is categorized by temporary pauses in breathing while sleeping. This can happen to anyone but what makes it “gestational” is when your sleep apnea symptoms occur: during pregnancy and immediately postpartum.

Common symptoms of sleep apnea include:

• Loud snoring
• Daytime sleepiness
• Headache, dry mouth, or sore throat upon waking
• Gasping or choking during the night
• Gestational hypertension (high blood pressure)
• Weight gain or obesity
• Irritability or mood swings

We know these last two can be hard to differentiate as symptoms during pregnancy. Nevertheless, mention them to your primary care physician, obstetrics team, or gynecology experts.

Additional signs may be more obvious to someone who is pregnant. Dr. Jessica Madden, a board-certified pediatrician and neonatologist of over 15 years and the Medical Director of our parent company’s Mom & Baby division, says, “Women who are obese when they get pregnant are at the highest risk of having sleep apnea during pregnancy (15-20% of obese women have sleep apnea). Pregnant women are at a higher risk of sleep apnea during pregnancy due to weight gain and also changes in the oropharyngeal region during pregnancy that lead to narrowing of the airway.”

Obesity and pregnancy-related hormonal changes aren’t the only reasons your airways narrow while creating new life. Blood vessels become inflamed, causing upper airway tissues to swell and may reduce lung function. Additionally, lung function can decrease due to crowding as the uterus grows and starts to put pressure on or displace surrounding organs.

Now juggling the biological changes of growing a human and (potentially) OSA, it’s important to mentally prepare yourself for some difficulty and discomfort, especially if you’d been diagnosed with sleep apnea previously. But, don’t worry; Aeroflow Sleep is here to help you understand how important it is to properly identify and treat OSA during pregnancy, because it could save more than one life!

“Yes, pregnant women with sleep apnea are at an increased risk of cardiomyopathy (enlarged heart), congestive heart failure, pulmonary embolism (blood clot in the lungs), and death,” Dr. Madden explains. Thus, if you are hurt, your baby can be, too.

OSA has also been associated with low birth weights and fetal growth anomalies; including both Small and Large for Gestational Age (SGA & LGA) infants. That said, not all of the studies agree. Dr. Madden reveals, “The scientific evidence showing these associations is conflicting (i.e. for every study that shows sleep apnea and gestational diabetes may be linked, there is another study not showing a relationship between the two).

“There is, by far, the strongest evidence base for sleep apnea during pregnancy increasing the risk of hypertensive disorders and pre-eclampsia. This makes sense, since we know that sleep apnea greatly increases the risk of developing high blood pressure in non-pregnant individuals.”

OSA is a well-studied condition with many forms of successful treatment, so it’s always best to follow the medical advice of your OB-GYN and take care of yourself before the baby comes. Keeping your blood pressure, oxygen, and sugar levels healthy during pregnancy creates the potential for a far healthier pregnancy, delivery, and neonatal period for both mother and baby. Untreated sleep apnea does not.

Dr. Madden confirms, “CPAP is a safe treatment for sleep apnea during pregnancy, and [a CPAP machine] is actually the treatment of choice for sleep apnea during pregnancy.” But you can’t get a CPAP without a diagnosis, so you’ll first want to ask your healthcare provider for a sleep study, of which there are two: 

• Polysomnography is an in-lab sleep study, overseen by a sleep specialist. This is the most comprehensive and accurate type of testing and is safe during pregnancy.
• Home sleep testing could also be arranged. This test is performed in the comfort of your home; however, it is typically unattended by a physician, may not be covered by insurance, and does not always provide as accurate of results.

In either case, testing is non-invasive and monitors a lot; like your overnight airflow, oxygen levels, and AHI (or Apnea-Hypopnea Index.) AHI is the measurement that helps doctors determine if obstructive sleep apnea treatment is necessary and to what degree based on your severity of sleep disordered breathing.

Luckily, if you are diagnosed with sleep apnea, you have a number of treatment options available during pregnancy. Your doctor may recommend:

• Positional therapy, wherein you support or train your body to achieve certain sleep positions for maximum airflow.
• Over-the-counter decongestants to reduce nasal congestion and open up airways.
• Weight management to keep weight gain from getting out of control. Albeit normal during pregnancy is normal, obesity in all body types leads to a high risk of developing or worsening OSA. This pertains to obese pregnant women too.

CPAP therapy will likely be prescribed in combination with the options listed above. CPAP stands for continuous positive airway pressure, and it is a completely non-invasive nightly breathing treatment. This form of sleep medicine is provided through a CPAP machine, which produces air pressure that keeps your airways from collapsing.

It may seem scary at first—for your baby as much as yourself, but rest easy; there is not yet reason to believe that sleep apnea (or CPAP) causes miscarriage. Dr. Madden assures, “Although there is an association between sleep apnea and pregnancy complications that might increase the risk of miscarriage (i.e. pre-eclampsia), there have not been any studies showing a direct link between sleep apnea and miscarriage.” You can count on us!

As your body heals postpartum, be sure to treat your gestational OSA as if it hasn’t gone away. Sleep apnea may become less noticeable, but it is important to continue treatment until you and your doctor decide together on next steps. After all, gestational OSA may not resolve after giving birth.

Keep in mind that sleep becomes even more elusive and more important to address after birth too! Always talk to your doctor about any health concerns regarding sleeping or breathing. You need as much rest as you can get!

None of this needs to be stressful. Aeroflow Sleep takes the headache out of healthcare and gets you set up with PAP supplies through insurance. We are in network with most primary and secondary insurance providers and are even accredited by Medicare and Medicaid. All you have to do is fill out a simple questionnaire to check your eligibility and tell us which (if any) PAP supplies you currently use. It’s as simple as that!

Nearing your due date? Aeroflow Breastpumps can help with that side of things! From breast pumps to maternity compression and postpartum recovery, discover the motherhood essentials covered. Just provide your insurance information here too.

No matter what you need at this time…breathe, sleep, and dream deeply, Mama. You’ve got this!

References

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Raynes-Greenow CH, Hadfield RM, Cistulli PA, Bowen J, Allen H, Roberts CL. Sleep apnea in early childhood associated with preterm birth but not small for gestational age: a population-based record linkage study. Sleep. 2012 Nov 1;35(11):1475-80. doi: 10.5665/sleep.2192. PMID: 23115396; PMCID: PMC3466794.

Lungeanu-Juravle L, Patrascu N, Deleanu OC, Cinteza M. The Role of Obstructive Sleep Apnea in Developing Gestational Hypertension and Preeclampsia. Maedica (Bucur). 2016 Dec;11(4):330-333. PMID: 28828052; PMCID: PMC5543527.

Street LM, Aschenbrenner CA, Houle TT, Pinyan CW, Eisenach JC. Gestational Obstructive Sleep Apnea: Biomarker Screening Models and Lack of Postpartum Resolution. J Clin Sleep Med. 2018 Apr 15;14(4):549-555. doi: 10.5664/jcsm.7042. PMID: 29609706; PMCID: PMC5886432.